The Effect of Initial Management of Ventilation on the Incidence of Bronchopulmonary Dysplasia and Other Morbidities in Neonates Born at 24th–27th Weeks of Gestation at Clinic of Neonatology Slovak University Hospital Nove Zamky
Authors:
K. Demová; G. Magyarová; A. Bystrická
Authors place of work:
Novorodenecká klinika FNsP, Nové Zámky
prednosta doc. MUDr. F. Bauer, PhD.
Published in the journal:
Čes-slov Pediat 2010; 65 (9): 503-509.
Category:
Original Papers
Summary
Objective:
Evaluation of the incidence of bronchopulmonary dysplasia (BPD) and other comorbidities on the basis of initial ventilation management in the delivery room.
Methods:
Retrospective analysis of data from newborns born at Clinic of Neonatology University Hospital Nove Zamky, at 24th–27th weeks of gestation, from birth until discharge, during the period from 01. 01. 2005 to 31. 12. 2009. Patients were infants who were in the delivery room initially intubated and prophylactic surfactant was administered followed by N-CPAP (nasal continuous positive pressure in pulmonary passages) and babies who after surfactant administration continued on mechanical ventilation. In addition, the incidence of various types of BPD (classification according to NICHD, National Institute of Child Health and Human Development), comorbidities, length of hospitalization, and administration of postnatal steroids were observed in both groups.
Results:
The results of our retrospective analysis showed significantly lower incidence of mild forms of BPD in the group of newborns with gestation 24+0 to 27+6 weeks initially stabilized by early administration of surfactant and N-CPAP compared with newborn stabilized by early surfactant administration followed by mechanical ventilation (25% vs. 70%; p=0.001). The incidence of secondary forms of BPD was lower in group N-CPAP compared with MV (5% vs. 12.5%, p=0.361).
Conclusion:
Immediate extubation after surfactant administration to N-CPAP in neonates with gestation 24+0 to 27+6 weeks has shown decrease in the incidence of BPD, and other comorbidities as well as in shortening the length of hospitalization.
Key words:
delivery room, ELBWI (extremely immature newborns), resuscitation, CPAP, intubation, surfactant
Zdroje
1. Aly H, Massaro AN, El-Mohandes AAE. Can delivery room management impact the length of hospital stay in premature infants? J. Perinatol. 2006; 26: 593–596.
2. Bohlin K, Jonsson B, Gustafsson AS, et al. Continuous positive airway pressure and surfactant. Neonatology 2008; 93: 309–315.
3. Booth C, Premkumar MH, Yannoulis A, et al. Sustainable use of continuous positive airway pressure in extremely preterm infants during the first week after delivery. Arch. Dis. Child Fetal. Neonatal. Ed. 2006; 91: 398–402.
4. Clark RH, Gerstmann DR, Jobe AH, et al. Lung injury in neonates: causes, strategies for prevention and long-term consequences. J. Pediatr. 2001; 139: 478–486.
5. Dani C, Bertini G, Pezzati M, et al. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks’ gestation. Pediatrics 2004; 113: 560–563.
6. Dunn MS, Reilly MC. Approaches to the initial respiratory management of preterm neonates. Paediatr.Respir. Rev. 2003; 4: 2–8.
7. Fanaroff AA, Stoll BJ, Wright LL, et al. NICHD Neonatal Research Network: Trends in neonatal morbidity and mortality for very low birth weight infants. Am. J. Obstet. Gynecol. 2007; 196: 14 147.1–147. e8.9.
8. Finer NN, Carlo WA, Duara S, et al. Delivery room continuous positive airway pressure/positive endexpiratory pressure in extremely low birth weight infants: a feasibility trial. Pediatrics 2004; 114: 651–657.
9. Geary C, Caskey M, Fonseca R, et al. Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration: A historical cohort study. Pediatrics 2008; 121(1): 89–96.
10. Halliday H. Surfactant, past, present and future. J. Perinatol. 2008; 28: S47–S56.
11. Halliday HL. Continuous positive airway pressure. Acta Paediatr. 1993; 82: 1028–1028.
12. Hermes-DeSantis ER, Clyman RI. Patent ductus arteriosus: pathophysiology and management. J. Perinatol. 2006; 26: S14–S18.
13. Jobe A, Bancalari E. Bronchopulmonary dysplasia. Am. J. Respir. Crit. Care Med. 2001; 163: 1723–1729.
14. Jobe A. Antenatal factors and the development of bronchopulmonary dysplasia. Semin. Neonatal. 2003; 8: 9–17.
15. Jobe AH, Ikegami M. Mechanism initiating lung injury in the preterm. Early Hum. Dev. 1998; 53: 81–94.
16. Kamper J, Ringsted C. Early treatment of idiopathic respiratory distress syndrome using binasal continuous positive airway pressure. Acta Paediatr. Scand. 1990; 79: 581–586.
17, Kobaly K, Schluchter M, Minich Net, et al. Outcomes of extremely low birth weight (<1000 g) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia: effects of practice changes in 2000 to 2003. Pediatrics 2008; 121: 73–81.
18. Kramer BW. The respiratory distress syndrome (RDS) in preterm infants. Intensivmedizin und Notfallmedizin 2007; 44(7): 403–408.
19. Kraybill EN, Runyan DK, Bose CL, et al. Risk factors for chronic lung disease in infants with birth weights of 751 to 1000 grams. J. Pediatr. 1989; 115: 115–120.
20. Landmann E, Misselwitz B, Steiss JO. Mortality and morbidity of neonates born at <26 weeks gestation (1998–2003). A population based study. J. Perinatol 2008. online; doi: 10.1515/JPM.2008.016.
21. Lundstrom KE, Griesen G. Early treatment with nasal CPAP. Acta Paediatr. 1993; 82: 856–856.
22. Lundstrøm KE. Early nasal continuous positive airway pressure for preterm neonates: the need for randomized trials. Acta Paediatr. 2003; 92: 1124–1126.
23. Morley CJ, Davis PG, Doyle LW, et al. COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N. Engl. J. Med. 2008; 358(7): 700–708.
24. Plavka R, Keszler M. Interaction between surfactant and ventilatory support in newborns with primary surfactant deficiency. Biology of the Neonate 2003; 84(1): 89–95.
25. Sekar KC, Corff KE. To tube or not to tube babies with respiratory distress syndrome. To tube or not to tube in RDS. J. Perinatol. 2009; 29: 68–72.
26. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst. Rev. 2001; CD000510.
27. Stevens TP, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst. Rev. Issue 3, 2004.
28. Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst. Rev. 2005; 3: CD001243–CD001243.
29. Sweet DG, Halliday HL. The use of surfactants in 2009. Arch. Dis. Child Educ. Pract. Ed. 2009; 94: 78–83.
30. Te Pas AB, Lopriore E, et al. Early respiratory management of respiratory distress syndrome in very preterm infants and bronchopulmonary dysplasia: A case-control study. PLoS ONE 2007; 2(2): 192.
31. Te Pas AB, Walther FJ. Ventilation of very preterm infants in the delivery room. Current Pediatric Reviews 2006; 2: 87–197.
32. Tommiska V, Heinonen K, Lehtonen L, et al. No improvement in outcome of nationwide extremely low birth weight infant population between 1996–1997 and 1999–2000. Pediatrics 2007; 119: 29–36.
33. Van Marter LJ, Allered EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics 2000; 105(6): 1194–1201.
34. Verder H, Albertsen P, Ebbesen F, et al. Surfactant and Nasal-Cpap Before 30 Weeks of Gestation. European Society for Pediatric Research Abstracts. September 1997; Vol. 42, Issue 3, 414.
35. Vestník MZ zo dňa 12. decembra 2008, čiastka 57, číslo 23344/2008OZS: Odborné usmernenie MZ SR pre profylaxiu a liečbu syndrómu dychovej tiesne novorodencov exogénnym surfaktantom.
36. Sweet DG, Carnielli V, Greisen G, et al. Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update. Neonatology 2010; 97: 402–417.
Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
2010 Číslo 9
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