Ventilated Preterm Infants Research Articles

A new tool to assess patient-ventilator synchrony in preterm infants receiving non-invasive ventilation: a randomized crossover pilot study.

Nasal synchronized intermittent positive pressure ventilation (nSIPPV) is an effective non-invasive ventilation technique, especially for preterm infants. Patient-ventilator synchrony is essential for providing effective respiratory support; however, no automated system is currently available for monitoring this parameter. A new tool for automatic assessment of patient-ventilator synchrony, the SyncNIV system, was developed and applied in this pilot study to evaluate differences between nSIPPV and non-synchronized nasal intermittent positive pressure ventilation (nIPPV) in preterm infants with respiratory distress. This study involved designing a custom algorithm for signal analysis. Data were collected through a polygraph that could simultaneously gather respiratory data from the patients and ventilator. Patient-ventilator synchrony was evaluated by applying the SyncNIV system in a randomized crossover study designed to compare nSIPPV and nIPPV. The primary outcome was the mean instant Synchrony Index (i-SI), defined as the portion of the inspiration effort sustained by ventilator inflation, expressed as a percentage. Fourteen infants with a median (IQR) gestational age of 28.6 (25.6-30.3), were enrolled. We analyzed 43,304 ventilator inflations and 50,221 patient breaths. The i-SI was 54.69% (44.49-60.09) in nSIPPV and 39.54% (33.40-48.75) in nIPPV, p<0.05. The SyncNIV system confirmed better i-SI during nSIPPV than during nIPPV, demonstrating its effectiveness in assessing the differences between these two modes of non-invasive ventilation in preterm infants. The SyncNIV system could be a useful tool for optimizing the ventilation parameters and improving the effectiveness and comfort of respiratory support systems.

Premature Infants Show Consistently Good Lung Compliance During Conventional Mechanical Ventilation.

Many extremely small preterm infants need to be intubated and mechanically ventilated during their intensive care stay. Animal studies indicate that lung compliance can deteriorate rapidly under conventional ventilation. This study investigated whether this presumed deterioration in compliance actually occurs in extremely small preterm infants. Data from 56 conventionally ventilated preterm infants born from 2016 to 2022 at 25.22 weeks' gestation (±1.47) and 678.71 g (±138.14) birth weight were retrospectively analysed. This study investigated how dynamic compliance changed over the course of ventilation. The infants were conventionally ventilated from 7.25 days of life (±5.59) for 2.68 days (±2.35). Compliance at the beginning was 0.37 mL/cmH2O/kg (±0.17), after 1 h 0.38 mL/cmH2O/kg (±0.16), after 3 h 0.40 mL/cmH2O/kg (±0.20), after 6 h 0.44 mL/cmH2O/kg (±0.23), after 24 h 0.46 mL/cmH2O/kg (±0.17) and after 48 h 0.43 mL/cmH2O/kg (±0.13). The increase in compliance compared to baseline was statistically significant after 12 (p = 0.016) and 24 h (p = 0.042). Ventilation was performed with a PEEP of 7.51 cmH2O (±1.16) and a peak pressure of 20.64 cmH2O (±2.73). All received surfactant after birth and 21 (37.5%) also at the start of conventional ventilation. During conventional ventilation in premature infants after administration of surfactant and with basically recruited lungs, no deterioration in compliance was observed either in the short or long term. The PEEP of almost 7.5 cmH2O used may have contributed to the fact that the deterioration described in the animal model did not occur in the preterm infants.

Elective high frequency oscillatory ventilation versus conventional mechanical ventilation on the chronic lung disease or death in preterm infants administered surfactant: a systematic review and meta-analysis.

Use of elective high frequency oscillatory ventilation (HFOV) compared with conventional mechanical ventilation (CMV) results in a small reduction in the risk of chronic lung disease (CLD) or death, but the evidence is weak. Our objective was to explore whether elective HFOV was associated with less CLD or death as compared with CMV in preterm infants administered surfactant. We conducted a systematic review and meta-analysis, including 1835 ventilated participants from 11 randomized controlled trials comparing elective HFOV with CMV between February 1993 and February 2014. The primary outcome was the incidence of CLD or death. Compared with CMV, elective HFOV was associated with less CLD or death (relative risk (RR) 0.76, 95% confidence interval (CI) 0.61-0.94, p = 0.01) (p = 0.01, I2 = 55%), CLD (RR 0.71, 95%CI 0.53-0.93, p = 0.01) (p = 0.03, I2 = 50%), and ≥2nd stages of retinopathy of prematurity (RR 0.77, 95%CI 0.62-0.94, p = 0.01) (p = 0.42, I2 = 0%). In the subgroup of > 1 dose of surfactant, compared with CMV, elective HFOV was also related to less CLD or death (RR 0.87, 95%CI 0.77-0.98, p = 0.02) (p = 0.10, I2 = 42%). No differences were found in the incidences of death, grade 3 or 4 of intraventricular hemorrhage, periventricular leukomalacia, airleak and necrotizing enterocolitis between the two groups. Elective HFOV is superior to CMV in reducing the incidence of CLD or death in ventilated preterm infants administered surfactant, especially in the subgroup of >1 dose of surfactant. International Prospective Register of Systematic Reviews: No.: CRD42022301033; URL: https://www.crd.york.ac.uk/PROSPERO/ .

Applied forces with high vs. low resuscitation table during neonatal ventilation: a randomized crossover manikin study.

In a neonatal manikin model, the lower force applied during positive pressure ventilation with the resuscitation table at the operator's navel may be a desirable goal, but the clinical validations should be assessed in further studies. clinicaltrial.gov NCT06254651. • Apnoea and bradycardia may occur more frequently when higher forces are exerted during face mask ventilation in preterm infants immediately after birth • As the quality of the ventilation may be influenced by procedure-related factors such as the position of the patient, we hypothesized that the height of the resuscitation table could influence the applied forces during the procedure. • In a neonatal manikin model, the lower force applied during face mask ventilation with the resuscitation table at the operator's navel may be a desirable goal. • Further studies in a clinical setting are warranted.

68 Feasibility of applying synchronized and proportional negative pressure ventilation in preterm infants with respiratory distress (NeoVest)

Abstract Background In preterm infants, application of negative pressure ventilation (NPV) may offer advantages to traditional methods of nasal continuous positive airway pressure (nCPAP). In a pre-clinical model, we recently described the “NeoVest”, a system consisting of a sealed abdominal interface and a ventilator that applies NPV in synchrony and in proportion to the diaphragm electrical activity (Edi) (Beck 2022). In animals with loaded breathing, the Neovest allowed a 50% reduction in Edi, and demonstrated specific diaphragm unloading, without hemodynamic effects. The NeoVest system, and its interface, have yet to be evaluated in human infants. Objectives The aim of the study was to evaluate the feasibility of applying synchronized and proportional NPV with an abdominal interface in infants with respiratory distress. Design/Methods This is a prospective feasibility trial. The inclusion criteria were admission to the Neonatal Intensive Care Unit with respiratory distress, birthweight&amp;gt;1.5kg, &amp;lt;6 weeks of age, FiO2 &amp;lt;0.35, clinically stable with no recent apneas and bradycardias, nCPAP &amp;lt;8 cm H2O and at least 48 hrs old, or post-extubation. After parental consent, the feeding tube was exchanged for a 6F “Edi catheter” (for feeding and measuring Edi), and sensors were placed (heart rate, oxygen saturation, transcutaneous CO2, and non-invasive blood pressure (BP)). Figure 1 shows the Neovest interface on a manikin. The five protocol steps were: nCPAP ON/NeoVest OFF (10 min), nCPAP ON/NeoVest ON (10 min), NO ASSIST (1 min), NeoVest only medium (10 min), NeoVest high (5 min), NeoVest low (5 min). Results Eight babies have been included to this point. The principal diagnoses were Respiratory Distress Syndrome and/or Transient Tachypnea of the Newborn. Mean weight was 2186±480g and age 10±8 days old. All babies tolerated the physical application of the vest. As shown in Figure 2, there was no significant difference in Edipk when the vest was placed (12.4±5.5 vs. 11.1±3.5 uV). During the period of no assist, Edipk was higher (18.8 ±7.3 uV) than nCPAP or NeoVest periods (p= 0.012), which were not significantly different from each other. Neural respiratory rate was the same for all periods tested. As per its design, the Neovest system delivered negative pressure in synchrony and in proportion to the Edi. Negative pressures applied (□PVEST) were -9±4, -11±4, and -7±5 cmH2O (Figure 2) for the three NeoVest periods. All infants were clinically stable with no disruptions to vital signs. Conclusion Applying synchronized and proportional negative pressure with the NeoVest system was feasible and showed promise with regards to diaphragm unloading. Future studies are required to evaluate the NeoVest utility for longer periods and compared to other methods of respiratory support.

Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study

ObjectivesTo evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.Study designProspective quasi-experimental observational study.SettingTertiary perinatal neonatal unit.Patients50 very preterm infants being...

Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study

ObjectiveTo determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants.DesignProspective interventional crossover study.SettingNeonatal intensive care unit.PatientsVentilated preterm...

Delayed sustained lung inflation for preterm neonates in neonatal intensive care unit: a randomized controlled trial

IntroductionSustained lung inflation (SLI) right after birth to decrease the use of mechanical ventilation of preterm infants is controversial because of potential harm. This randomized controlled trial was conducted to evaluate the effectiveness and safety of delayed SLI in neonatal intensive care unit (NICU).MethodsPreterm neonates requiring continuous positive airway pressure after birth were eligible for enrollment. In the experimental group, SLI with 20 cm H2O for 15 s was conducted by experienced staff in the NICU between 30 min and 24 h after birth.ResultsA total of 45 neonates were enrolled into this study, including 24 in the experimental group and 21 in the control group. There was no significant difference in the birth condition between the experimental and control groups, including gestational age (p = 0.151), birth weight (p = 0.692), and Apgar score at 1 min (p = 0.410) and 5 min (p = 0.518). The results showed the duration of respiratory support was shorter in the experimental group than the control group (p = 0.044). In addition, there was no significant difference in the other outcomes, such as pneumothorax, patent ductus arteriosus, and bronchopulmonary dysplasia.ConclusionOur findings indicate that sustained inflation conducted by experienced staff in the NICU is safe. The data suggest that SLI conducted by experienced staff in the NICU after stabilization could serve as an alternative management for preterm infants with respiratory distress. However, the reduction in use of respiratory support should be interpreted cautiously as a result of limited sample size.Trial registrationUniversity hospital Medical Information Network (UMIN) Clinical Trials Registry: UMIN000052797 (retrospectively registered).

RAM Cannula versus Short Binasal Prongs for Non-invasive Ventilation in Preterm Infants: An Updated Systematic Review and Meta-analysis.

To compare the efficacy and safety of RAM cannula with short binasal prongs (SBPs) as nasal interfaces in preterm infants requiring nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). The authors searched electronic databases (Medline, Embase, and Web of Science) and trial registries from inception until March 15, 2024, for randomized controlled trials (RCTs) comparing the RAM cannula with SBP for delivering nCPAP/NIPPV. They performed a random-effects meta-analysis using RevMan 5.4 software. The primary outcome was failure of nCPAP/NIPPV. Secondary outcomes included nasal injury, mechanical ventilation, air leaks, and mortality. Five RCTs (825 participants) were included. There was no significant difference in nCPAP/NIPPV failure (RR: 1.04; 95%CI: 0.58 to 1.87) or the need for invasive mechanical ventilation (RR: 1.23; 95%CI: 0.75 to 2.01) between the RAM cannula and SBP groups (low to very low certainty). Compared with infants in the SBP group, those in the RAM cannula group had a significantly lower incidence of moderate to severe nasal injury [(5 RCTs, 825 participants; RR: 0.34; 95%CI: 0.18 to 0.66); low certainty] and any nasal injury [(RR: 0.44; 95%CI: 0.26 to 0.76; very low certainty)]. There was no significant difference in the other clinical outcomes. In comparison to SBP, the RAM cannula may have little to no effect on nCPAP/NIPPV failure, but the evidence is very uncertain. Low-certainty evidence suggests that the use of RAM cannula possibly results in reduction in moderate to severe nasal trauma in preterm infants receiving nCPAP/NIPPV.

Use of dexmedetomidine during mechanical ventilation in extremely preterm and extremely low birth weight neonates receiving morphine: A single-center retrospective study.

Analgesia and sedation are often provided during mechanical ventilation in extremely preterm neonates. Opioids and benzodiazepines are the most frequently used agents but can have adverse effects. Dexmedetomidine, an alpha-2 agonist, might be interesting to spare opioid and benzodiazepine use. The objective of this study was to describe a cohort of mechanically ventilated extremely, preterm infants treated with morphine with or without dexmedetomidine. This was a retrospective, observational, single-center study in the neonatal intensive care unit of Creteil. We included preterm neonates born before 28 weeks of gestation and/or weighting less than 1000 g hospitalized between July 2017 and June 2020, on mechanical ventilation for at least 72 h and who received morphine with or without dexmedetomidine as a second- or third-line treatment. We described morphine and midazolam exposure, respiratory, and digestive outcomes for patients who received dexmedetomidine and those who did not. Twenty nine preterm infants received morphine and dexmedetomidine, and 44 received morphine without dexmedetomidine. Dexmedetomidine was used in patients of 25.7 [25.1-26.7] weeks, 680 [600-750] g and significantly more often in patients with vascular complications during pregnancy (p = 0.008), intrauterine growth restriction (p = 0.01) and in patients who received higher cumulative doses of morphine (p = 0.01). Morphine and midazolam doses tended to decrease after the introduction of dexmedetomidine. Dexmedetomidine was never discontinued because of side effects. In this study, dexmedetomidine, used as a second or third-line treatment during mechanical ventilation, was associated with a decrease in morphine and midazolam doses after introduction. Dexmedetomidine was used in a specific population of extremely preterm infants, with severe respiratory disease, who required prolonged mechanical ventilation and high morphine doses. This study highlights the need for pharmacokinetic/pharmacodynamic studies in this population, followed by randomized controlled trials and studies on the long-term effects of dexmedetomidine to determine its place in analgosedation of ventilated preterm infants.

Subglottic dilatation in extremely preterm infants on prolonged mechanical ventilation

BackgroundAirway injuries are reported among preterm infants with bronchopulmonary dysplasia. We hypothesized that prolonged ventilation in preterm infants is associated with subglottic dilatation that can be reliably evaluated by point of care ultrasonography (POCUS). MethodsAll preterm infants (<29-weeks) admitted to the neonatal ICU at the Advent-Health from January-2020 to June-2022 were eligible if they required invasive ventilation for ≤7 days in the first 28 days of life (control) or remained intubated for ≥28 days (prolonged ventilation). Sonography was performed by one technician and all images were reviewed by the pediatric radiologist. The trachea size was measured 3 times by randomly selecting three images. The first 20 scans were also independently reported by a different pediatric radiologist. Intra and inter-observer variability was estimated. Mean trachea size and weight at the time of imaging were compared. ResultsOut of 417 eligible infants; 11 died before 28 days and 163 required ventilation for 8–27 days. Consent missed for 80 infants during COVID-19 pandemic. We enrolled 23 and 28 infants in the control & prolonged ventilation groups, respectively. Inter and intra-observer correlations were 0.83 and 0.97 respectively. Infants in the control group had higher gestation and birth weight. Infants on prolonged ventilation were at higher risk for infections, BPD, longer hospital stay and significant subglottic dilation (4.51 ± 0.04 vs 4.17 ± 0.02 mm, p < 0.01) despite smaller body weight at the time of imaging (884 ± 102 vs 1059 ± 123g, p < 0.01). ConclusionExtremely preterm infants on prolonged ventilation are at risk for sub-glottic dilatation that can be reliably measured by POCUS.

Slowing lung deflation by increasing the expiratory resistance enhances FRC in preterm rabbits.

As very preterm infants have surfactant-deficient and highly incompliant lungs, slowing lung deflation during expiration might help preserve functional residual capacity(FRC) during lung aeration. In this study, we investigated the effect of expiratory resistance(Re) on lung aeration during positive pressure ventilation in preterm rabbits immediately after birth. Preterm rabbit pups were delivered at 29 days gestation, mechanically ventilated from birth and simultaneously imaged to measure lung aeration using phase-contrast X-ray. Re was varied by altering the length (0, 60 or 1000 mm) of the expiratory circuit. Increasing Re led to a decrease in lung deflation rates and both peak expiratory flows and flow rates at mid-deflation. As a result, the rate of de-acceleration(slowing) in lung deflation when approaching FRC was markedly reduced with increasing resistance. During lung aeration, FRC was significantly different between resistance groups and was significantly higher over time in the high compared to the low resistance group. While FRC values tended to be higher with higher Re, they were not significantly different at end-ventilation (t = 7 min). Increasing Re of the ventilation circuit during lung aeration in preterm rabbits immediately after birth decreased lung deflation rates and increased the accumulation of FRC over time. The expiratory phase of the ventilatory cycle has been largely overlooked as an opportunity to improve ventilation in preterm infants after birth. Increasing the expiratory resistance of the ventilator circuit during lung aeration in preterm rabbits immediately after birth markedly decreased lung deflation rates and increased FRC accumulation, compared to a low expiratory resistance. This indicates that ventilation devices that reduce the "work of breathing" by reducing the expiratory resistance, may have the unintended effect of reducing FRC, particularly in extremely preterm infants that have surfactant deficient highly incompliant lungs.

Comparison of neurally adjusted ventilatory assist and synchronized intermittent mandatory ventilation in preterm infants after patent ductus arteriosus ligation: a retrospective study

ObjectiveThis study aimed to compare the efficacy of neurally adjusted ventilatory assist (NAVA) to synchronized intermittent mandatory ventilation (SIMV) in preterm infants requiring mechanical ventilation after patent ductus arteriosus (PDA) ligation.MethodsA retrospective analysis was conducted on intubated preterm infants who underwent PDA ligation at our hospital from July 2021 to January 2023. Infants were divided into NAVA or SIMV groups based on the ventilation mode after surgery.ResultsFifty preterm infants were included. During treatment, peak inspiratory pressure (PIP) and mean airway pressure (MAP) were lower with NAVA compared to SIMV (PIP: 19.1 ± 2.9 vs. 22.4 ± 3.6 cmH2O, P < 0.001; MAP: 9.1 ± 1.8 vs. 10.9 ± 2.7 cmH2O, P = 0.002). PaO2 and PaO2/FiO2 were higher with NAVA (PaO2: 94.0 ± 11.7 vs. 84.8 ± 15.8 mmHg, P = 0.031; PaO2/FiO2: 267 [220–322] vs. 232 [186–290] mmHg, P = 0.025). Less sedation was required with NAVA (midazolam: 1.5 ± 0.5 vs. 1.1 ± 0.3 μg/kg/min, P < 0.001).ConclusionCompared to SIMV, early use of NAVA post PDA ligation in preterm infants was associated with decreased PIP and MAP. Early NAVA was also associated with reduced sedation needs and improved oxygenation. However, further studies are warranted to quantify the benefits of NAVA ventilation.

Temporal effects of caffeine on intrapulmonary shunt in preterm ventilated infants.

We hypothesized that caffeine would be associated with a transient reduction in the right-to-left shunt and VA/Q. We aimed to explore the temporal effects of caffeine on right-to-left shunt, ventilation perfusion ratio (VA/Q) and shift of the oxyhaemoglobin dissociation curve (ODC) in premature ventilated infants. Retrospective cohort study at a tertiary neonatal unit of infants born at less than 31weeks of gestation that were mechanically ventilated on day three of life. The non-invasive method of the ODC was used to determine the right-to-left shunt, VA/Q and shift before and at 1, 4 and 20 h after a maintenance dose of caffeine citrate. A total of 21 infants were included with a median (range) gestational age of 27 (23.7-30.7) weeks. The median shunt percentage was significantly reduced, compared to baseline at 1 h (8 (range: 7-9) % vs. 4 (range: 0-6) %, p=0.042) and 4 h post caffeine administration (8 (range: 7-9) % vs. 0 (range: 0-3) %, p=0.042), but the VA/Q and the right shift of the ODC did not differ significantly between these time points. At 20 h, there were no significant differences between these indices compared to baseline values. Caffeine led to a transient decrease in intrapulmonary shunt from one to 4 h after administration and this may be due to its diuretic action.

Effects of high frequency non-invasive ventilation in premature newborn infants: systematic review protocol

Introduction: Premature birth is a condition, which can be induced by several factors. High Frequency non-invasive ventilation is a promising new mode of non-invasive ventilation that aims to offer adequate ventilation and oxygenation, but much has yet been discussed about its effectiveness and safety. Objective: To evaluate the effectiveness and safety of high frequency non-invasive ventilation in premature infants. Methods: To this end, we will carry out a systematic review. The study protocol was recorded on the Prosperous Platform. We will include premature newborns who used high-frequency non-invasive ventilation requiring ventilation as an initial support, after extubation or as a rescue mode (after failure of initial non-invasive therapy). The searches will be carried out in the databases: Medical Literature Analysis and Retrieval System Online (Medline) via Pubmed, Excerpta Medica dataBASE (Embase) via Elsevier, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library Portal and Physiotherapy Evidence Database We will evaluate the methodological rigor of the included studies and the certainty of the evidence of the main outcomes of the systematic review using Cochrane's Risk of Bias 2.0 tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. The selection of studies, data extraction, evaluation of the bias of the included studies and evaluation of the certainty of the evidence will be carried out by two independent researchers. Expected Results: The results of this review are expected to present a critical and up-to-date summary of the topic and facilitate safer decision-making by physiotherapists regarding the best recommendation for ventilatory support in the NICU, based on the best scientific evidence currently available.

The possible role of artificial intelligence in deciding postnatal steroid management in extremely premature ventilated infants.

Clinical decision support (CDS) has shown a positive effect on physicians. There is variability among physicians about using postnatal steroids (PNS) in preterm (PT) infants. It is, therefore, essential to develop tools supporting the decision to use PNS in PT infants. We propose a model using online tools such as CDS in deciding to use PNS in PT infants. We combined the online bronchopulmonary dysplasia (BPD) estimator and extubation success calculator tools to be used as a simple bedside tool assisting decisions about using PNS in ventilated PT infants.

Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia

BackgroundDuring stabilisation of preterm infants at birth, a face mask is used to provide respiratory support. However, application of these masks may activate cutaneous stretch receptors of the trigeminal nerve, causing apnoea and bradycardia. This study investigated the amount of force exerted on the face mask during non-invasive ventilation of preterm infants at birth and whether the amount of exerted force is associated with apnoea and bradycardia. MethodsA prospective observational study was performed in preterm infants born <32 weeks of gestation who were stabilised at birth. During the first 10 minutes of respiratory support, we measured breathing and heart rate as well as the amount of force exerted on a face mask using a custom-made pressure sensor placed on top of the face mask. ResultsThirty infants were included (median (IQR) gestational age(GA) 28+3 (27+0–30+0) weeks, birthweight 1104 (878–1275) grams). The median exerted force measured was 297 (198–377) grams, ranging from 0 to 1455 grams. Significantly more force was exerted on the face mask during positive pressure ventilation when compared to CPAP (410 (256–556) vs 286 (190–373) grams, p = 0.009).In a binary logistic regression model, higher forces were associated with an increased risk of apnoea (OR = 1.607 (1.556–1.661), p < 0.001) and bradycardia (OR = 1.140 (1.102–1.180), p < 0.001) during the first 10 minutes of respiratory support at birth. ConclusionDuring mask ventilation, the median exerted force on a face mask was 297 grams with a maximum of 1455 grams. Higher exerted forces were associated apnoea and bradycardia during the first 10 minutes of respiratory support at birth.

Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial.

Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.

Association between opioid use during mechanical ventilation in preterm infants and evidence of brain injury: a propensity score-matched cohort study

Preterm infants often require mechanical ventilation (MV), which can be a painful experience. Opioids (such as morphine) are used to provide analgesia, despite conflicting evidence about their impact on the developing brain. We aimed to quantify the use of opioids during MV in infants born at <32 weeks' gestational age and to investigate the association between opioid use and evidence of brain injury. In this retrospective propensity score-matched cohort study, we used routinely recorded data from the National Neonatal Research Database to study infants born at 22-31 weeks gestational age who were admitted to neonatal units in England and Wales (between Jan 1, 2012, and Dec 31, 2020) and who were mechanically ventilated on one or more days during their hospital stay. We used propensity score matching to identify pairs of infants (one who received opioids during MV and one who did not) with similar demographic and clinical characteristics. The pre-specified primary outcome was preterm brain injury assessed in all infants who received MV for more than two days and had evidence of preterm brain injury at or before discharge from neonatal care. Adjusted analyses accounted for differences in infants' characteristics, including illness severity and painful/surgical conditions. Of 67,206 infants included, 45,193 (67%) were mechanically ventilated for one or more days and 26,201 (58% of 45,193) received an opioid whilst ventilated. Opioids were given for a median of 67% of ventilated days (IQR 43-92%) and the median exposure was 4 days (2-11). The percentage of mechanically ventilated infants who received opioids while ventilated increased from 52% in 2012 to 60% in 2020 (morphine, 51%-56%; fentanyl, 6%-18%). In the propensity score-matched cohort of 3608 pairs who were ventilated for >2 consecutive days, the odds of any preterm brain injury (adjusted odds ratio 1.22, 95% CI 1.10-1.35) were higher in those who received opioids compared with those who did not (received opioids, 990/3608 (27.4%) vs. did not receive opioids, 855/3608 (23.7%). The adjusted odds of these adverse outcomes increased with increasing number of days of opioid exposure. Use of opioids during mechanical ventilation of preterm infants increased during the study period (2012-2020). Although causation cannot be determined, among those ventilated for >2 consecutive days, these data suggest that opioid use is associated with an increased risk of preterm brain injury and the risk increases with longer durations of exposure. University of Nottingham Impact Fund.

Removal of bronchial foreign body in a ventilated preterm infant with flexible bronchoscopy.

Removal of bronchial foreign body in a ventilated preterm infant with flexible bronchoscopy.