A pilot study to determine whether external stabilisation of the chest wall reduces the need for mechanical ventilation in preterm infants (original) (raw)

2010, South African Journal of …

Respiratory distress syndrome (RDS), caused by surfactant deficiency, is a common cause of respiratory failure in preterm infants. RDS is treated by administration of exogenous surfactant and ventilatory support as needed, in the form of intermittent positive-pressure ventilation (IPPV) or continuous distending pressure (CDP). Bronchopulmonary dysplasia (BPD) remains a problem, despite improvements in the technique of conventional positive-pressure ventilation, so non-invasive forms of ventilation such as nasal continuous positive airways pressure (NCPAP) are of interest. 1 NCPAP together with permissive hypercapnia appears to decrease the incidence of BPD significantly. 2 NCPAP is currently widely used in the management of RDS in preterm infants. 2-5 Surfactant therapy with early extubation to NCPAP decreases the need for intubation and ventilation, 6-8 shortens the duration of mechanical ventilation, decreases the need for subsequent surfactant therapy 9 and decreases BPD in extremely low-birth-weight (ELBW) infants. Whether NCPAP should be started immediately at birth or delayed until the baby has signs of RDS is still unclear 10-13 and is currently under evaluation. 14 The application of NCPAP immediately after birth may reduce the need for subsequent surfactant therapy. 13 NCPAP is also useful in facilitating extubation and managing the apnoea of prematurity. While highly effective, NCPAP is not always successful 15 and may be associated with complications such as pneumothorax, 13 a greater risk of early-onset sepsis in ELBW infants 16 and the development of nasal trauma. Continuous negative airways pressure (CNEP) is another way of delivering CDP. CNEP was found to be physiologically equivalent to positive end-expiratory pressure (PEEP) in an animal model of acute lung injury 19 and is effective in the management of RDS in preterm infants. 20,21 However, while NCPAP has gained favour, CNEP has remained largely un-utilised. The systems used to apply CNEP are often Daynia E Ballot, MB BCh, FCP (Paed), PhD Peter A Cooper, MB ChB, DCH, FCP (Paed), PhD Barbara J Cory, RN, DNEd Sithembiso Velaphi, MB BCH, FCP (Paed), MMed (Paed), Fellowship Neonatology A pilot study to determine whether external stabilisation of the chest wall reduces the need for mechanical ventilation in preterm infants S S A J o u r n a l of C h i l d H e al th