Trends in respiratory management and morbidities of very preterm or very low birth weight infants from 2000 to 2013: results from a Portuguese tertiary level Neonatal Intensive Care Unit (original) (raw)
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Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units
Revista Portuguesa de Pneumologia (English Edition), 2010
Resumo Com o advento do surfactante, dos corticosteróides prénatais e dos avanços na tecnologia, a sobrevida dos recém-nascidos de extremo baixo peso tem melhorado dramaticamente. As taxas de displasia broncopulmonar (DBP) variam amplamente entre unidades, e vários estudos, avaliando resultados de múltiplas intervenções, têm mostrado alguma melhoria na prevalência da DBP. A implementação de potenciais boas práticas na DBP tem sido adoptada por muitos serviços nas últimas décadas. Objectivo: Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as práticas clínicas no tratamento dos recém-nascidos de mui-Abstract With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades. Aim: To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units Recebido para publicação/received for publication: 09.06.29 Aceite para publicação/accepted for publication: 09.09.08
Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates
European Journal of Pediatrics
The development of devices that can fix the tidal volume in high-frequency oscillatory ventilation (HFOV) has allowed for a significant improvement in the management of HFOV. At our institution, this had led to the earlier use of HFOV and promoted a change in the treatment strategy involving the use of higher frequencies (above 15 Hz) and lower high-frequency tidal volumes (VThf). The purpose of this observational study was to assess how survival without bronchopulmonary dysplasia grades 2 and 3 (SF-BPD) is influenced by these modifications in the respiratory strategy applied to preterm infants (gestational age < 32 weeks at birth) who required mechanical ventilation (MV) in the first 3 days of life. We compared a baseline period (2012-2013) against a period in which this strategy had been fully implemented (2016-2017). A total of 182 patients were exposed to MV in the first 3 days of life being a higher proportion on HFOV at day 3 in the second period 79.5% (n 35) in 2016-2017 vs 55.4% (n 31) in 2012-2013. After adjusting for perinatal risk factors, the second period is associated with an increased rate of SF-BPD (OR 2.28; CI 95% 1.072-4.878); this effect is more evident in neonates born at a gestational age of less than 29 weeks (OR 4.87; 95% CI 1.9-12.48). Conclusions : The early use of HFOV combined with the use of higher frequencies and very low VT was associated with an increase in the study population's SF-BPD. What is Known: • High-frequency ventilation with volume guarantee improve ventilation stability and has been shown to reduce lung damage in animal models. What is New: • The strategy of an earlier use of high-frequency oscillatory ventilation combined with the use of higher frequencies and lower tidal volume is associated to an increase in survival without bronchopulmonary dysplasia in our population of preterm infants. Keywords High-frequencyventilation. Lung protection. Bronchopulmonary dysplasia. Ventilatory-induced lung injury. Target tidal volume. Preterm infants Abbreviations ΔPhf Delta pressure BPD Bronchopulmonary dysplasia type 2-3 BW Birth weight CMV Conventional mechanical ventilation CRIB Critical index for babies DOL Days of life GA Gestational age HFOV High-frequency oscillatory ventilation Hz Hertz INSURE Intubation-surfactant administration-extubation LISA Less-invasive surfactant administration MV Mechanical ventilation nCPAP Nasal continuous airway pressure NEC Necrotizing enterocolitis Communicated by Daniele De Luca
Journal of Tropical Pediatrics, 2005
The purpose of this study was to identify the risk factors for bronchopulmonary dysplasia (BPD) in a population of very low birth weight (BW) newborns treated with mechanical ventilation in the first week of life who survived the 28 days. The effects of antenatal steroids, sepsis, patent ductus arteriosus (PDA), fluid management and ventilator support strategies were investigated. This was a prospective study of a cohort of 86 newborns with BW below 1500 g who were born alive between the period of September 2000 to November 2002, treated at the University Hospital of Medical School Campinas, Brazil. The BPD was defined as the oxygen dependence in the 28 days, with consistent radiology findings. A logistic regression analysis was realized to identify the risk factors associated to BPD. Among the very low BW newborns, 45 developed BPD. The univariate analysis showed that besides BW and gestational age (GA), other factors such as FiO 2 ! 0.60 (RR : 2.03; 95% CI: 1.4-2.94),
Acta Paediatrica, 2007
To describe and analyse neonatal care, short and long-term morbidity with special reference to ventilatory support and chronic lung disease (CLD) in a population-based study. Methods: During 1994 and 1995 a prospective, nationwide , multicentre study was conducted, comprising 477 liveborn infants with gestational age (GA) <28 wk and/or birthweight <1000 g. Of these, 407 infants received active treatment. The ventilatory treatment was based on the principle of permissive hypercapnia and early nasal continuous positive airway pressure (NCPAP) supplemented with surfactant and ventilator therapy in case of CPAP failure. Results: Among actively treated infants 85% received CPAP and 23% mechanical ventilation from the first day of life. A total of 269 infants (56%) survived to discharge. Of these, 195 had a GA <28 wk. One-hundred and five survivors with GA <28 wk survived with NCPAP as sole respiratory support. In surviving infants, periventricular leucomalacia/intraventricular haemorrhage grade 3-4 was found in 10%, retinopathy of prematurity grade >2 in 4%, and oxygen requirement at 36 and 40 wk of postmenstrual age (CLD) in 16 and 5%, respectively. Three infants either died of CLD (n = 1) or required oxygen therapy beyond 43 wk of postmenstrual age. Logistic regression analysis showed significant associations between oxygen requirement at 40 wk and GA, septicaemia, mechanical ventilation, symptomatic patent ductus arteriosus and Clinical Risk Index for Babies score. Only the two lastmentioned factors proved significant in infants with GA <28 wk. No infant died after discharge and 253 (94%) were followed up at 2 y of corrected age; one or more moderate to severe impairments were found in 66 (26%) of the examined children. Conclusion: Ventilatory treatment in extremely premature and extremely low-birthweight infants based on early NCPAP and permissive hypercapnia may result in comparable survival rates and sensorineural outcome; however, the incidence of CLD seems lower than that reported on conventional treatment.
Wiadomości Lekarskie
The aim of the study was to analyze and identify risk factors for the development of moderate and severe bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis in preterm neonates in intensive care unit and during any kind of respiratory support. Materials and methods: A simple retrospective-prospective blind controlled non-randomised study included 28-32 weeks of gestational age 122 newborns with respiratory distress syndrom, who were treated in the neonatal intensive care units of two medical institutions of Dnipro from 2016 to 2020. Among 122 children neonates were divided into two groups according to particularities of respiratory support, prior type of noinvasive ventilation and infusion volume per day. The uni-variate Cox regressions using clinical variables identified specific clinical variables associated with development of moderate and severe BPD, retinopathy of prematurity, necrotizing enterocolitis, mortality rate (based on odds ratio and 95% c...
Journal of Ankara University Faculty of Medicine
Objectives: Despite improvements in neonatal care and survival of preterm infants, the incidence of bronchopulmonary dysplasia (BPD) is not decreasing. The aim of this study was to evaluate the impact of initial mode of respiratory support on BPD in extremely low birth weight (ELBW) infants. Materials and Methods: ELBW infants admitted to neonatal intensive care unit were analyzed retrospectively between 2014 and 2017. The effects of initial respiratory support options and morbidities on BPD were evaluated between infants who developed BPD or not. Results: Total 101 infants were evaluated, and 68 were included. For those whose incidence of BPD was 46%, the mean gestational age and birth weight were 27.8±1.8 weeks and 814±118 g, respectively. Patients with BPD (n=31) had a lower mean gestational age and birth weight, higher rates of necrotizing enterocolitis and retinopathy of prematurity (p<0.001, p=0.012, p=0.024, and p=0.018, respectively). Requirement of surfactant and need for invasive respiratory support initially after birth were found to be major risk factors for BPD. The duration of invasive ventilation after birth was longer in patients with BPD (p=0.034). BPD or death occurred in 66 of 101 infants. Infants received non-invasive respiratory support after birth had a lower risk for BPD, and BPD or death. Conclusion: To prevent the development of BPD in ELBW infants, the respiratory support should be non-invasive after birth, and if the infant is intubated, duration of invasive respiratory support should be shortened for less than 3 days.
Lung protective ventilatory strategies in very low birth weight infants
Journal of Perinatology, 2008
Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.
Pulmonology, 2018
Introduction: Although non-invasive forms of ventilation have recently spread in neonatology, invasive ventilation still plays a key role in the support of extremely low birth weight (ELBW) infants. The purpose of this study was to assess changes in neonatal ventilation practices for ELBW infants and compare outcomes between two epochs (2005-2009 vs. 2010-2015) to analyze progression stemming from the implementation of newer clinical guidelines. Materials and methods: We conducted a retrospective study with data collection from all ELBW infants born between 2005 and 2015 in our center through their individual clinical records. The main outcome was the prevalence of bronchopulmonary dysplasia (BPD) in both periods. Assessment of other morbidities and survival were secondary outcomes. Results: A hundred and thirty-one infants were included; median gestational age of 27 weeks (23-33) and mean birth weight of 794.58 g (±149.37). Invasive mechanical ventilation (IMV) was performed on 103 (78.6%) infants. Non-significant increases in the use of non-invasive mechanical ventilation (NIMV) were observed between epochs both exclusively and following IMV. In conventional ventilation there were significant variations between epochs, namely a decrease in synchronized intermittent mandatory ventilation (SIMV) and a major growth in the addition of volume guarantee (VG). Significant decreases in BPD (from 50.9% to 32.0%) and cystic periventricular leukomalacia (cPVL) (from 27.5% to 10.7%) were observed between epochs, with no major changes in other morbidities and survival. Conclusion: Changes in our neonatal intensive care unit's ventilatory practices according to the most up-to-date guidelines, have led to a decrease in BPD and cPVL, over an 11-year period.
Critical Care Research and Practice, 2012
Survival and outcomes for preterm infants with respiratory distress syndrome (RDS) have improved over the past 30 years. We conducted a study to assess the changes in perinatal care and delivery room management and their impact on respiratory outcome of very low birth weight newborns, over the last 15 years. A comparison between two epochs was performed, the periods before and after 2005, when early nasal continuous positive airway pressure (NCPAP) and Intubation-SURfactant-Extubation (INSURE) were introduced in our center. Three hundred ninety-five clinical records were assessed, 198 (50.1%) females, gestational age 29.1 weeks (22-36), and birth weight 1130 g (360-1498). RDS was diagnosed in 247 (62.5%) newborns and exogenous surfactant was administered to 217 (54.9%). Thirty-three (8.4%) developed bronchopulmonary dysplasia (BPD), and 92 (23%) were deceased. With the introduction of early NCPAP and INSURE, there was a decrease on the endotracheal intubation need and invasive ventilation (P < 0.0001), oxygen therapy (P = 0.002), and mortality (P < 0.0001). The multivariate model revealed a nonsignificant reduction in BPD between the two epochs (OR = 0.86; 95% CI 0.074-9.95; P = 0.9). The changes in perinatal care over the last 15 years were associated to an improvement of respiratory outcome and survival, despite a nonsignificant decrease in BPD rate.
Respiratory support strategies for the preterm newborn – National survey 2008
2009
Introdução: As estratégias de suporte ventilatório utilizadas no recém -nascido têm sido motivo de grande investigação. Objectivos: Avaliar as práticas de suporte ventilatório nas unidades de neonatologia nacionais utilizadas na assistência ao recém -nascido de extremo baixo peso e avaliar se estão em conformidade com a prática baseada na evidência. Métodos: Foi enviado, por via electrónica, a 31 unidades de neonatologia nacionais, um inquérito sobre Abstract Background: Respiratory support strategies for the preterm newborn have been the subject of intense research. Aim: To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials. Methods: Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators, modes of ventilation, lung function monitoring, use of exogenous surfactant, oxygen saturation