Use of Lung Ultrasound to Improve Timeliness of Surfactant Replacement in Respiratory Distress Syndrome: Are we Ready?
The management of respiratory distress syndrome (RDS) is generally based on the clinical presentation and the increasing fraction of inspired oxygen (FiO2) requirement, which guides clinicians to consider administering surfactant. However, the dilemma regarding the ideal time to administer surfactant still exists. Early use of surfactant (within 2 hours of postnatal life) in RDS will decrease pneumothorax and bronchopulmonary dysplasia, and improve survival.1-3 The identification of an infant who requires surfactant is usually based on the infant's requirement of supplemental O2.
Conclusion HFNC and nCPAP have no significant differences as a primary mode of respiratory support in preterm infants, in the time to wean off the devices and oxygen support, respiratory distress syndrome and bronchopulmonary dysplasia incidence, hospitalization duration, and rates of complications of prematurity. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents | Abstract | Full text
Conclusion: FiO2 in the second hour of life is a significantpredictor of CPAP failure. The threshold of 0.29 best discriminates the CPAP outcome. Nonresponders to CPAP have a remarkably higher incidence of complications and a higher mortality rate.Neonatology
Abstract INTRODUCTION: There are limited data available regarding the fraction of inspired oxygen (FiO2) predictive of the failure of continuous positive airway pressure (CPAP) in preterm infants with respiratory distress syndrome (RDS). Therefore, we investigated factors predictive of CPAP failure in the first 72 h of life, with special attention to the prognostic role of FiO2. METHODS: This multicenter, prospective study enrolled infants
Traditionally, surfactant has been administered to preterm infants with respiratory distress syndrome via an endotracheal tube and in conjunction with mechanical ventilation. However, negative consequences of mechanical ventilation such as pneumothorax and bronchopulmonary dysplasia are well known. In order to provide the benefits of surfactant administration without the negative effects of mechanical ventilation, several methods of less invasive surfactant administration have been developed. These methods include InSurE (intubate, surfactant, extubate), pharyngeal administration, laryngeal mask administration, aerosolized...
This study tries to investigate the potential capability of inhaled budesonide in the prevention of BPD in newborns with gestational age of
CONCLUSIONS: Risks and benefits of NAVA compared to other forms of ventilation for neonates are uncertain. Well-designed trials are required to evaluate this new form of triggered ventilation. PMID: 29077984 [PubMed - as supplied by publisher]
CONCLUSIONS: Infants ventilated using VTV modes had reduced rates of death or BPD, pneumothoraces, hypocarbia, severe cranial ultrasound pathologies and duration of ventilation compared with infants ventilated using PLV modes. Further studies are needed to identify whether VTV modes improve neurodevelopmental outcomes and to compare and refine VTV strategies. PMID: 29039883 [PubMed - as supplied by publisher]
CONCLUSIONS: Selective use of minimally invasive surfactant therapy at 29-32 weeks gestation permits a primary CPAP strategy to be pursued with a high rate of success, and a low risk of pneumothorax. PMID: 28922658 [PubMed - as supplied by publisher]
Conclusions: Selective use of minimally invasive surfactant therapy at 29-32 weeks gestation permits a primary CPAP strategy to be pursued with a high rate of success, and a low risk of pneumothorax.Neonatology 2018;113:7-14
CONCLUSIONS: Sustained inflation was not better than intermittent ventilation for reducing mortality in the delivery room and during hospitalisation. The number of events across trials was limited, so differences cannot be excluded. When considering secondary outcomes, such as need for intubation, need for or duration of respiratory support, or bronchopulmonary dysplasia, we found no evidence of relevant benefit for sustained inflation over intermittent ventilation. The duration of mechanical ventilation was shortened in the SLI group. This result should be interpreted cautiously, as it can be influenced by study character...