Mechanical Ventilation Of Newborn Research Articles

ВЛИЯНИЕ ГЕСТАЦИОННОГО ВОЗРАСТА НОВОРОЖДЕННЫХ НА ТЕЧЕНИЕ НЕОНАТАЛЬНОГО ПЕРИОДА ПРИ АНОМАЛИЯХ ИНВАЗИИ ПЛАЦЕНТЫ

Objective of the study: to determine the timing of optimal delivery and to identify the features of the course of the neonatal period in children from mothers with placental accreta. Materials and methods of research: the analysis of medical records of 140 children of mothers with placental accreta (main group) and 60 newborns of mothers without placental accreta (comparison group) of various gestational ages (GA), born in the period of 2014–2020, was carried out. The paper presents the results of a single-center retrospective non-randomized continuous comparative study. Results: the effect of GA on the length of the newborn's stay in the neonatal intensive care and intensive care units (ICU) and the hospital as a whole was confirmed. The dependence of the need for respiratory support in newborns on the gestational age was confirmed: with a decrease in GA, the need for respiratory support in newborns increases statistically significantly (p=0.0011), the need for traditional mechanical ventilation in newborns increases statistically significantly (p<0.001). When analyzing the frequency of occurrence of asphyxia, no statistically significant differences were found in the main group and in the comparison group. There were no statistically significant differences (p=0.229) in the body weight of newborns developing during pregnancy complicated by placenta previa compared with newborns born to mothers without a placental invasion anomalies. As a result of our study, there were no statistically significant differences in the length of stay in ICU and hospital for newborns of the same GA of the main group and the comparison group.

Outcome, Clinical Profile and Risk Factors for Mortality of Neonates Necessitating Mechanical Ventilation

Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results

A Numerical Analysis of Mechanical Ventilation in Newborns

A Numerical Analysis of Mechanical Ventilation in Newborns

Use of the Electrical Impedance Segmentography system in a neonatal respiratory distress case

Introduction: The Electrical Impedance Segmentography system (EIS) is a technique able to detect any kind of dishomogeneities between the pulmonary segments and to study the air distribution and the regional current volumes, by monitoring the impedance in the four pulmonary quadrants, in a continuous, non-invasive, fast and low-cost manner. We used this method for the management of a patient born at term with respiratory distress. Case Report: On admission to the ward, a noninvasive respiratory assistance was set up. The chest X-ray showed a massive opacity of the left hemithorax as due to a pulmonary atelectasis. Therefore, we decided to administer surfactant by the ET tube using the INSURE technique, with a slight, clinical and radiological improvement. At the same time, we started to monitor our patient ventilation using the EIS: in agreement with the radiological findings, it revealed an initial exclusion of the left, lower, pulmonary lobe and a progressive lung recruitment. It also showed immediate changes of the EIS patterns after every therapeutic maneuver (airway aspiration, surfactant administration, PEEP variations). On the 10th day of life a clinical stabilization and a complete radiological resolution were achieved, so the baby was weaned from the respiratory assistance. Conclusion: The presented case, in agreement with the literature, shows that the EIS can represent a safe and effective guide to set up the mechanical ventilation in newborns. In fact, it supplies a non-invasive and immediate assessment of ventilation, highlighting the poor ventilated areas and allowing immediate therapeutic adjustments.

Short Term Outcome of Preterm Neonates Required Mechanical Ventilation

Background: Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the western world and neighboring countries, neonatal ventilation in our country is still in its infancy. To analyze the common indications and outcome of preterm neonates required mechanical ventilation.Methods: This was a retrospective observational study conducted on preterm neonates required mechanical ventilation over a period of 12 months (July 2013 to June 2014).Results: A total of 50 neonates were mechanically ventilated during the study period of which 68% (n=34) survived. The survival rate was higher (77%) in 34- <37 weeks Gestational Age (GA) group and gradually declined in 30- <34 weeks (71%) & 27- <30 weeks (56%) GA. The neonates with Birth Weight (BW) ? 2500gm were higher survivals which was 100% and lower in 1500-2499gm (81%), 1000-1499gm (68%) and 800-999gm (33%) BW groups. Inborn neonates (68%) showed marginally higher survivals than outborn (66%) and also more survivals observed in preterm baby girls (72%) than boys (65%). RDS (62%) was the commonest indication for ventilation followed by Neonatal Sepsis (14%), Perinatal Asphyxia (PNA-10%), Congenital Pneumonia (8%) and Pneumothorax (6%). And found higher survivals in RDS (77%) than other indications which were in Pneumothorax (66%), PNA (60%), Sepsis (57%) and Pneumonia (50%). RDS (n=31) with surfactant therapy (n=14) recovered earlier <7 days (71.43%) than non surfactant therapy neonates (n=17), they required prolonged ventilator support over 7days (82.35%).Conclusions: Mechanical ventilation reduces the neonatal mortality, hence facilities for neonatal ventilation should be included in the regional and central hospitals providing intensive care for neonates.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 9-13

Indication and short term outcome of Mechanical Ventilation in Neonates in a tertiary care hospital

Background: Mechanical ventilation of newborn has been practiced for several years with advances in many ways. As compared to the western world, neonatal ventilation in our country started in recent years.Subjects, Methods and Results: A retrospective chart review was conducted to analyze the common indications and outcome of neonates requiring mechanical ventilation in neonatal intensive care unit at Ad-Din Medical College Hospital from January 2012 to July 2013. Fifty eight neonates were ventilated over a period of 19 months of whom 39 (67.24%) survived. Respiratory distress syndrome was the commonest indication for ventilation (32.75%), followed by Perinatal asphyxia (18.96%), Pneumonia (13.79%), Neonatal Sepsis (13.79%), Meconium aspiration syndrome 6(10.16%) & Pneumothorax 6 (10.16%). Among the babies who survived, 35(89.74%) were managed solely with conventional ventilator and 4 babies required both conventional and High Frequency Oscillatory (HFOV) ventilation. Survival rate was higher where birth weight >2500gm (76.19%) and gestational age 34-37 weeks (88.88%). Survival rates was (69.23%) in <30 weeks and 60% in <1000 g. Prolong ventilator support was needed for Respiratory Distress Syndrome without surfactant (mean 254 hrs), Perinatal asphyxia (mean 187hrs) and Neonatal sepsis (mean 187hrs). Common complications were Pneumonia (12.06%), Pneumothorax (10.34%), sepsis (8.6%) & Pulmonary hemorrhage (3.4%). Survival rate was higher in babies requiring mechanical ventilation for respiratory distress syndrome (84.21%).Conclusion: Use of surfactant could decrease the duration of ventilation and mortality further in babies with respiratory distress syndrome.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.24-28

A novel fiber-optic measurement system for the evaluation of performances of neonatal pulmonary ventilators

Published standards for the performance evaluation of pulmonary ventilators are mainly directed to manufacturers rather than to end-users and often considered inadequate or not comprehensive. In order to contribute to overcome the problems above, a novel measurement system was proposed and tested with waveforms of mechanical ventilation by means of experimental trials carried out with infant ventilators typically used in neonatal intensive care units: the main quantities of mechanical ventilation in newborns are monitored, i.e. air flow rate, differential pressure and volume from infant ventilator are measured by means of two novel fiber-optic sensors (OFSs) developed and characterized by the authors, while temperature and relative humidity of air mass are obtained by two commercial transducers. The proposed fiber-optic sensors (flow sensor Q-OFS, pressure sensor P-OFS) showed measurement ranges of air flow and pressure typically encountered in neonatal mechanical ventilation, i.e. the air flow rate Q ranged from 3 l min−1 to 18 l min−1 (inspiratory) and from −3 l min−1 to −18 l min−1 (expiratory), the differential pressure ΔP ranged from −15 cmH2O to 15 cmH2O. In each experimental trial carried out with different settings of the ventilator, outputs of the OFSs are compared with data from two reference sensors (reference flow sensor RF, reference pressure sensor RP) and results are found consistent: flow rate Q showed a maximum error between Q-OFS and RF up to 13 percent, with an output ratio QRF/QOFS of not more than 1.06 ± 0.09 (least square estimation, 95 percent confidence level, R2 between 0.9822 and 0.9931). On the other hand the maximum error between P-OFS and RP on differential pressure ΔP was lower than 10 percent, with an output ratio ΔPRP/ΔPOFS between 0.977 ± 0.022 and 1.0 ± 0.8 (least square estimation, 95 percent confidence level, R2 between 0.9864 and 0.9876). Despite the possible improvements, results were encouraging and suggested the proposed measurement system can be considered suitable for performances evaluation of neonatal ventilators and useful for both end-users and manufacturers.

Bundle Method In Reducing Pneumonia Associated With Mechanical Ventilation In Newborns And Children: Integrative Review

Infections related to health care are a public health problem, given the repercussions of the event to the morbidity and mortality of the population and having health spending. Pneumonia Associated to Mechanical Ventilation has the incidence of 8.1% to 57.1% in neonates and 23% in children. This study is an integrative literature review aimed to check the scientific production concerning the use of bundle guidelines to reduce of PAV in children and newborns in intensive care units and analyze the results of these research. For data collection, the keyword bundle, and the descriptors infant, newborn; Intensive Care Units, Neonatal Pneumonia, Ventilator-Associated and Child(ren) for online search in databases: PUBMED, SCOPUS, LILACS and CINHAL. The initial result of the search was 891 articles and after application of inclusion and exclusion criteria, the sample resulted in nine articles. This study points out that in general VAP prevention measures found in bundles were effective in reducing PAV rates in neonates and pediatric patients. However, there are still differences in the development of some interventions, especially for newborns. It is necessary to develop other studies, including the better level of evidence to address the use of bundle for PAV prevention of these population, considered more vulnerable to incidents related to health care.

Lung recruitment strategies

Mechanical ventilation in newborns, children and adults leads to lung injury and has been shown to induce the formation of proteinaceous lung oedema causing epithelial disruption and resulting in changes in lung perfusion. Lung injury leads to reduced compliance, worsening of shunt fraction and an inflammatory response that results from high end-inspiratory transpulmonary pressures (Ptp) and inadequate End Expiratory Lung Volume (EELV). Lung injury results if a lung is ventilated from collapsed state with each ventilator cycle. Thus the first concept of treatment in acute hypoxic respiratory failure is: “Open collapsed lung units and keep them open without overdistending them”. The open lung is one in which there is little or no atelectasis and an optimal gas exchange. Lung recruitment strategies transiently increase Ptp to reopen the alveolar units not aerated or poorly aerated but recruitable. Lung recruitment maneuvers may restore EELV resulting in more stable alveoli, and reduce shear stress associated with the alveolar cyclic opening and closing. Lung recruitment can be performed in several ways: in delivery room with a T-piece device, in the NICU setting by using a conventional or high frequency oscillation (HFO) ventilator, and is commonly achieved by increase of end-expiratory lung volume with positive end expiratory pressure (PEEP) or end inspiratory lung volume by inspiratory holds or sustained inflation. Recruitment during both, HFO and CMV (Conventional Mechanical Ventilation), follows similar concepts when using small tidal volume ventilation but is easier to achieve at bedside during HFO. The Sustained Inflation maneuver (SI) applies a high pressure to the lung for a short period (30 sec) before returning to previous mean airway pressures. This volume recruitment strategy has been shown to be as protective as high frequency oscillatory ventilation (HFO) at similar lung volumes. Infants treated with a SI in delivery room had improved short-term respiratory outcomes (reduced need of tracheal intubation and mechanical ventilation), but major outcomes (BPD Bronchopulmonary dysplasia- and/or death) were not improved. Recent reports describe improvements in arterial oxygenation with the use of recruitment maneuvers during CMV and/or HFO. However, the impact of these strategies on patient important outcomes such as survival is still unclear. Further clinical studies are needed to evaluate the efficacy of SI, including selection of patients, setting of SI maneuver in terms of duration and peak pressure, timing of surfactant administration. Further studies are also needed to elucidate the impact of recruitment maneuvers during mechanical ventilation, including survival and BPD.

A novel simulator for mechanical ventilation in newborns: MEchatronic REspiratory System SImulator for Neonatal Applications.

Respiratory problems are among the main causes of mortality for preterm newborns with pulmonary diseases; mechanical ventilation provides standard care, but long-term complications are still largely reported. In this framework, continuous medical education is mandatory to correctly manage assistance devices. However, commercially available neonatal respiratory simulators are rarely suitable for representing anatomical and physiological conditions; a step toward high-fidelity simulation, therefore, is essential for nurses and neonatologists to acquire the practice needed without any risk. An innovative multi-compartmental infant respirator simulator based on a five-lobe model was developed to reproduce different physio-pathological conditions in infants and to simulate many different kinds of clinical scenarios. The work consisted of three phases: (1) a theoretical study and modeling phase, (2) a prototyping phase, and (3) testing of the simulation software during training courses. The neonatal pulmonary simulator produced allows the replication and evaluation of different mechanical ventilation modalities in infants suffering from many different kinds of respiratory physio-pathological conditions. In particular, the system provides variable compliances for each lobe in an independent manner and different resistance levels for the airway branches; moreover, it allows the trainer to simulate both autonomous and mechanically assisted respiratory cycles in newborns. The developed and tested simulator is a significant contribution to the field of medical simulation in neonatology, as it makes it possible to choose the best ventilation strategy and to perform fully aware management of ventilation parameters.

Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study

BackgroundThe use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). Howerver, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.Objective: To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.MethodsDesign: Prospective pre-intervention and post-intervention study.Setting: The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.Participants: In all, 230 (2006) and 383 (2008) patients were included.Intervention: In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.Outcome measures: The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.ResultsSignificant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481).The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.ConclusionsThis is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.

ABSTRACT 408

Background and aims: Mechanical ventilation (MV) can induce oxidative stres. Ischemia-modified albumin (IMA) is a new biomarker for the identification of myocardial ischemia. This study is aimed to investigate IMA production by induced oxidative stress during MV in newborns. Methods: This cross-sectional study was performed between September 2012 and June 2012. Seventeen newborns ventilated with SIMV (SIMV-group) and 20 ventilated with CPAP (CPAP-group) were included the study. Two blood samples were obtained from each newborns (one of them during ventilation and the second sample after cessation of ventilation). Total antioxidant capacity (TAC) and total oxidant status (TOS) were measured using Erel’s methods. IMA measured with ELISA kit (Cusabiso®). Oxidant stress index (OSI) was calculated. Statistical analyses were performed by using SPSS v.18.0. IRB approvall was taken. Results: No significant differences were found between SIMV and CPAP groups in mean gestation age and birth weight. IMA, TOS and OSI levels were significantly elevated during ventilation support (The mean 102.2 ± 9.3 IU/mL, 15.5 ± 1.3 µmolH2O2equivalent/L, and 0.85 ± 0.22 arbitrary unit [ABU], respectively), while decreased after cessation of ventilation support (the mean 82.9 ± 11.9 IU/mL, 13.4 ± 1.3 µmolH2O2equivalent/L, and 0.64 ± 0.14 ABU, respectively, p=0.001) for the entire study group. TAC was significantly decreased during ventilation support while eleveted after cessation of ventilation support for the entire study group. Conclusions: With respect to the mean TAC, OSI and IMA levels, no significant differences were observed between SIMV and CPAP groups. Further prospective studies are needed to compare the effect of different ventilation modes on oxidative stress and IMA levels.

Congenital Diaphragmatic Hernia: Not Quite There Yet

Congenital Diaphragmatic Hernia: Not Quite There Yet

Current Trends in Mechanical Ventilation of Newborns

Current Trends in Mechanical Ventilation of Newborns

An air flow sensor for neonatal mechanical ventilation applications based on a novel fiber-optic sensing technique

In this work, a simple and low-cost air flow sensor, based on a novel fiber-optic sensing technique has been developed for monitoring air flows rates supplied by a neonatal ventilator to support infants in intensive care units. The device is based on a fiber optic sensing technique allowing (a) the immunity to light intensity variations independent by measurand and (b) the reduction of typical shortcomings affecting all biomedical fields (electromagnetic interference and patient electrical safety). The sensing principle is based on the measurement of transversal displacement of an emitting fiber-optic cantilever due to action of air flow acting on it; the fiber tip displacement is measured by means of a photodiode linear array, placed in front of the entrance face of the emitting optical fiber in order to detect its light intensity profile. As the measurement system is based on a detection of the illumination pattern, and not on an intensity modulation technique, it results less sensitive to light intensity fluctuation independent by measurand than intensity-based sensors. The considered technique is here adopted in order to develop two different configurations for an air flow sensor suitable for the measurement of air flow rates typically occurring during mechanical ventilation of newborns: a mono-directional and a bi-directional transducer have been proposed. A mathematical model for the air flow sensor is here proposed and a static calibration of two different arrangements has been performed: a measurement range up to 3.00 × 10(-4) m(3)∕s (18.0 l∕min) for the mono-directional sensor and a measurement range of ±3.00 × 10(-4) m(3)∕s (±18.0 l∕min) for the bi-directional sensor are experimentally evaluated, according to the air flow rates normally encountered during tidal breathing of infants with a mass lower than 10 kg. Experimental data of static calibration result in accordance with the proposed theoretical model: for the mono-directional configuration, the coefficient of determination r(2) is equal to 0.997; for the bi-directional configuration, the coefficient of determination r(2) is equal to 0.990 for positive flows (inspiration) and 0.988 for negative flows (expiration). Measurement uncertainty δQ of air flow rate has been evaluated by means of the propagation of distributions and the percentage error in the arrangement of bi-directional sensor ranges from a minimum of about 0.5% at -18.0 l∕min to a maximum of about 9% at -12.0 l∕min.

Safety of recombinant human deoxyribonuclease as a rescue treatment for persistent atelectasis in newborns

BACKGROUND AND OBJECTIVEPulmonary problems are vitally important in newborns. Increased intense and mucoid secretions may lead to atelectasis, pulmonary infections, respiratory distress, prolonged mechanical ventilation or even death. The aim of this study was to evaluate the safety of recombinant human deoxyribonuclease (rhDNase) in the management of persistent atelectasis in term and preterm newborns, unresponsive to the conventional treatment.DESIGN AND SETTINGProspective study of patients admitted to a general community setting of a neonatal intensive care unit between December 2007 and December 2009.PATIENTS AND METHODSThe study included 22 patients (12 premature and 10 term) who were admitted to the neonatal intensive care unit because of respiratory distress and developed atelectasis, and were unresponsive to conventional treatment. Nebulized rhDNase was administered to all patients at a dose of 1 mg/m2 twice daily for 3 days. In patients who did not respond to 3 days of treatment, endotracheal rhDNase was administered at a dose of 1 mg/m2. We assessed the clinical (respiratory rate and oxygen requirement) and radiologic responses (chest radiographic score), recurrence of atelectasis, the need for a repetitive treatment, and mortality rate.RESULTSA clinical and radiologic improvement of atelectasis was observed in 18 of 22 patients following 3 days of nebulized rhDNase treatment. Atelectasis relapsed in 4 patients. Following the administration of combined endotracheal and nebulized rhDNase treatment, an improvement of atelectasis was noted in all four recurrent cases. No adverse events were observed in patients because of the rhDNase treatment.CONCLUSIONSrhDNase treatment is a safe option and may be used as an effective method for the management of persistent atelectasis in newborns, which is resistant to other conventional treatment methods.

Short-Term Outcome of Mechanical Ventilation in Neonates

Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the Western world and our neighbouring countries, neonatal ventilation in our country is still in its infancy. Objectives: To analyze the common indications and outcome of neonates requiring mechanical ventilation. Methods: This was a prospective observational study conducted on neonates requiring mechanical ventilation within first 24 hours of birth over a period of nine months. Results: Birth asphyxia was the commonest indication for ventilation (59.67%) followed by asphyxia with meconium aspiration syndrome (MAS) (17.74%), hyaline membrane disease (HMD) (8.06%), MAS (6.45%) and intrauterine pneumonia (6.45%). Out of 62 babies, 22 (35.48%) survived. Babies with asphyxia had highest survival rate (51.35%). Neonates with HMD did not survive. Term babies and babies weighing ≥2500g had higher survival rate of 40.47% and 41.46% respectively, while babies less than 32 weeks had survival rate of 16.66% only. Conclusions: Mechanical ventilation reduces the neonatal mortality; hence, facilities for neonatal ventilation should be included in the regional and central hospitals providing level II neonatal care. Key words: neonatal ventilation; hyaline membrane disease; low birth weight DOI: 10.3126/jnps.v31i1.3463J Nep Paedtr Soc 2010;31(1):35-38

Clinical practice

The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infants.

A new application of an old method for respiratory mechanics measurements: The passive inflation method in newborn infants during pressure‐controlled ventilation

We have previously described a passive inflation method during constant inspiratory flow for measuring total respiratory elastance and resistance during mechanical ventilation in newborns. The simple method for measuring respiratory mechanics had been assessed during decelerating inspiratory flow obtained with pressure controlled ventilation (PCV). We report an application of this method to preterm and full-term mechanically ventilated newborn infants and a comparison with the occlusion method. Twenty-one newborn infants (birth weight 1,060 to 3,650 g; gestational age 26 to 41 weeks), between 1 to 55 days of postnatal age, were enrolled in the study. They were ventilated with a "Servo ventilator 900C," first set in the pressure-controlled mode and then in the volume-controlled mode without changing the tidal volume (VT), inspiratory time or ventilator rate. Flow was measured through a pneumotachograph inserted between the endotracheal tube (ETT) and the breathing circuit; VT was obtained by integration of flow and airway pressure measured directly at the airway opening. Flow, volume, and pressure were plotted on analog X/Y tables to obtain pressure-volume (P/V) and flow-volume (V/V) loops, as well as pressure-time curves. Occlusion was performed by using the end-inspiratory and the end-expiratory pause buttons of the ventilator. The passive inflation method during PCV was based on the analysis of P/V and V/V loops and provided compliance (Crs(PC)infl.), resistance Rrs(PC)infl.) of the respiratory system, and intrinsic positive end-expiratory pressure (PEEP(PC)i,infl.). These values were compared with (1) compliance (Crs(PC)occl.) and intrinsic positive end-expiratory pressure (PEEP(PC)i,occl.) measured by the occlusion method during PCV; (2) static (Crs(VC),occl.) and dynamic (Crs(VC),dyn.) compliance, airway (R(aw)(VC),), tissue (Rrs(VC),visc.) and total resistance (Rrs(VC),occl.), and intrinsic positive end-expiratory pressure (PEEP(VC)i,occl.) measured by the occlusion method during volume-controlled ventilation. Crs(PC),infl. correlated well with Crs(PC),occl., Crs(VC),occl., and Crs(VC),dyn.. Furthermore, Crs(PC),infl. and Crs(VC),dyn. did not differ significantly. Rrs(PC),infl. correlated well and did not differ significantly from total inspiratory resistance, i.e., the sum of R(aw)(VC) and Rrs(VC),vis. PEEPPC,i,infl. correlated well and did not differ significantly from PEEP(PC)i.occl. and from PEEP(VC),i,occl. The passive inflation method can be used during PCV with a decelerating flow waveform. It provides dynamic compliance, inspiratory resistance of the respiratory system, and intrinsic PEEP from the analysis of V/V and P/V loops recorded at the airway opening. This technique is simple to use and well tolerated by preterm and full-term ventilated newborn infants. It can be a good alternative to occlusion methods.

Evaluation of mechanical ventilation in newborn infants. II. Pulmonary and neuro-developmental sequelae in relation to original diagnosis.

The incidence of bronchopulmonary dysplasia (BPD) and neuro-developmental sequelae in 135 infants surviving intermittent positive pressure ventilation (IPPV) in the newborn period were studied in relation to primary disorders requiring IPPV. The rate of BPD increased over the 6-year study period in hyaline membrane disease survivors from 14% to 28%, but decreased in infants with apnoea repetens from 38% to 13%. Immaturity seemed to be one important factor for development of BPD. The incidence of neuro-developmental sequelae in IPPV treated infants fell from 22% to 13% over the years. In infants with birth weight below 1501 g the rate of neurological handicaps was 11%.