Duration of mechanical ventilation and prediction of bronchopulmonary dysplasia and home oxygen in extremely preterm infants

2021 ◽  
Author(s):  
Theodore Dassios ◽  
Emma E. Williams ◽  
Ann Hickey ◽  
Anne Greenough
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Kirsten Glaser ◽  
Clyde J. Wright
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neonatal Lung ◽  
The Individual

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

scholarly journals Influence Of Time Under Mechanical Ventilation On Bronchopulmonary Dysplasia Severity In Extremely Preterm Infants: A Pilot Study.

2020 ◽  
Author(s):  
Vanessa Suziane Probst ◽  
Victoria Escobar ◽  
Darllyana Soares ◽  
Jane Kreling ◽  
Ligia Ferrari ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Roc Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chi Square ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD (M/S BPD) in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and M/S BPD. Methods: 53 PTNB were separated into mild and M/S BPD groups and their data were analyzed. Time under MV with a greater chance of developing M/S BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to M/S BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing M/S BPD was 36 days. M/S BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in M/S BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the M/S BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of M/S BPD.

scholarly journals Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Victoria Escobar ◽  
Darllyana S. Soares ◽  
Jane Kreling ◽  
Ligia S. L. Ferrari ◽  
Josiane M. Felcar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pilot Study ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Influence of Time Under Mechanical Ventilation on Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants: A Pilot Study.

2020 ◽  
Author(s):  
Victoria Escobar ◽  
Darllyana Soares ◽  
Jane Kreling ◽  
Ligia Ferrari ◽  
Josiane M. Felcar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Roc Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Common Disease ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: 53 PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.

Factors associated with long-term mechanical ventilation in extremely preterm infants

2018 ◽  
Vol 11 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Lina Yossef ◽  
Edward G. Shepherd ◽  
Susan Lynch ◽  
Kristina M. Reber ◽  
Leif D. Nelin
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Factors Associated ◽  
Extremely Preterm ◽  
Extremely Preterm Infants
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