Category: Respiratory

T-piece versus self inflating bag for resuscitation of VLBW infants

In a prospective multi-center observational study from Brazil of almost 2000 infants with a birth weight less than 1500 grams, compared to infants who received positive pressure at birth with a self-inflating bag (with no PEEP valve), those who received…

Review – congenital diaphragmatic hernia

In a comprehensive, well-illustrated review the authors summarize the current literature on congenital diaphragmatic hernia (CDH). Prenatally, severity can be assessed by the lung to head ratio (LHR) and position of the liver. Delivery at term is preferred, and management at birth includes…

Early low-dose hydrocortisone to prevent BPD

A multicenter double-blind randomized study from France of over 500 infants less than 28 weeks gestation compared the use of a ten-day course of intravenous hydrocortisone started by 24 hours after birth to placebo. Infants receiving hydrocortisone had a higher…

High-flow nasal cannula for initial respiratory support

A multicenter randomized trial compared the use of high-flow nasal cannula (HFNC) versus nasal CPAP for respiratory support in preterm infants greater than 28 weeks gestation with respiratory distress who had not received surfactant. Treatment failure was defined as an…

Antenatal steroids for late preterm and early term gestations

A systematic review with meta-analysis was performed of randomized clinical trials in singleton pregnancies 34 weeks gestation or greater, that compared the use of antenatal corticosteroids versus placebo or no treatment. Six trials with nearly 6000 women were included, including women at 37…

Multiple intubation attempts and IVH

A single-center retrospective study of over 300 infants less than 1500 grams birth weight found that infants with severe IVH had a higher number of intubation attempts in the first four days of life than infants with mild or no…

Antenatal betamethasone for late preterm delivery

A multicenter randomized trial of singleton pregnancies at 34 – 36 week gestation compared placebo versus betamethasone (two doses, 24 hours apart). There were around 1400 infants in each group. In the betamethasone group fewer infants developed respiratory problems than…

Signs of CPAP failure after birth

An observational study from one center used the results of pulmonary function testing in 32 preterm infants stabilized on CPAP immediately after birth to compare patterns in infants who failed CPAP versus those who succeeded. Respiratory interventions were recorded starting…

Poor repeatability of echo findings of PDA

In a prospective observational study very low birth weight preterm infants clinically suspected to have a patent ductus were subjected to echocardiography. Two different observers each performed an echocardiographic and Doppler ultrasound examination within 30 minutes of the other. There…

LISA for RDS

A multicenter randomized controlled trial from Germany in infants 23 – 26 weeks with respiratory distress syndrome compared traditional surfactant administration following endotracheal intubation and positive pressure ventilation, versus less invasive surfactant administration (LISA) where surfactant was administered through a thin…

Inhaled budesonide to prevent BPD

A multicenter randomized trial from Europe in infants 23 – 27 weeks tested the efficacy of inhaled budesonide compared to placebo. The medication was initiated within 24 hours of birth and continued until 32 weeks post-menstrual age or until discontinuation…

Videolaryngoscopy for intubation

A single-center randomized trial compared intubation of neonates (in the delivery room or in the NICU) by trainees using a videolaryngoscope where the screen was visible to the instructor in the intervention group and invisible in the control group. The…

Strategies to wean off nasal CPAP

A pilot randomized study compared four methods of weaning a baby off nasal CPAP – abruptly taking a baby off CPAP and placing on high-flow nasal cannula at 6 lpm (Group 1); abruptly taking a baby off CPAP to either…

Is resuscitation of preterm infants with room air risky?

In a retrospective cohort study of infants less than 27 weeks gestation from 17 Canadian NICUs, when compared to infants resuscitated with 100% oxygen, infants resuscitated with less than 100% (typically 21-40%) oxygen had a higher rate of severe neurologic injury or death (adjusted…

Vindication for the SUPPORT trial

Investigators of the SUPPORT trial have been criticized and accused (by parents and by the Office of Human Research Protection) of causing harm to babies enrolled in the trial even though this study was approved by multiple institutional review boards.…

Effects of hypoxemia or bradycardia in extremely preterm infants

An analysis of data from the multicenter (25 centers) Canadian Oxygen Trial of over 1000 infants 23 to 27 weeks gestation looked at the association between episodes of hypoxemia (oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds…

Bi-PAP vs CPAP

Low birth-weight nfants (n = 22) recovering from respiratory distress syndrome and requiring CPAP for greater than 24 hours were randomized to receiving CPAP either with bi-level nasal CPAP or conventional nasal CPAP (there was no blinding of interventions). Their…

Ventilatory control in chronic lung disease

In a prospective observational study of preterm infants less than 29 weeks gestation (part of the prematurity and respiratory outcomes project, PROP), infants who were either on supplemental oxygen or room air through a nasal cannula were subjected to a…

CPAP for Preterm Infants

A review article summarizes the available evidence on nasal CPAP and discusses implications for developing countries. Key points of this review are: In preterm infants less than 28 weeks gestation whose mothers have received antenatal steroids, CPAP is the preferred…

Does the RAM cannula deliver adequate CPAP?

An in-vitro study using an artificial airway model compared the mean airway pressure delivered by two types of devices, each attached to a ventilator – a standard nasal CPAP interface with the nares fully occluded, and RAM cannulae. The RAM…

Prediction of respiratory morbidity in BPD

A cohort study of preterm infants 23 – 28 weeks gestation from the UK studied the ability of three methods to predict respiratory outcomes at 24 months corrected age as assessed by respiratory health questionnaires. The three methods were: A BPD…

Sustained lung inflation at birth

A randomized trial of babies 25 – 28 weeks gestation compared two methods of initial stabilization after birth – nasal CPAP alone versus sustained lung inflation followed by nasal CPAP. Infants receiving the sustained lung inflation had a lower incidence of mechanical…

Lung ultrasound findings in meconium aspiration syndrome

In the first published description of lung ultrasound findings in meconium aspiration syndrome, a series of six neonates with meconium aspiration syndrome underwent lung ultrasound in the first few hours after birth. Dynamic findings noted on ultrasound were: B-pattern (interstitial)…

Lung-protective respiratory support in preterm infants

Lung injury in preterm infants receiving respiratory support can be decreased by avoiding: (1) Atelectrauma by promoting alveolar stability, (2) Volutrauma by limiting tidal volume to prevent alveolar overdistension, and (3) Oxitrauma by minimizing oxygen toxicity by improving ventilation-perfusion matching.…

Nasal trauma from nasal cannulae versus CPAP

A randomized trial compared the incidence and severity of nasal trauma in preterm infants less than 32 weeks gestation managed with either nasal CPAP or with heated humidified high-flow nasal cannulae in the seven days after extubation. Nasal trauma was…

Maternal antidepressant therapy and PPHN

A systematic review examined the association between maternal therapy with antidepressants and neonatal persistent pulmonary hypertension (PPHN). Seven studies were included. Quantitative analysis was possible only for studies using selective serotonin uptake inhibitors. Exposure to SSRIs late in pregnancy was…

Periviable birth: Workshop summary

The findings of a Joint Workshop held by leading organizations in obstetric and pediatric/neonatal care were recently published in multiple journals and contains summaries and recommendations about obstetric and neonatal management. Highlights of this report: The term perviable birth was…

Reducing unplanned extubations

A quality improvement project in one neonatal intensive care unit attempted to reduce unplanned extubations through the use of multiple practices implemented through serial plan-do-study-act cycles. The practices were: use of two or more staff for procedures at risk of extubation (such…

Yale researchers in the news

A March of Dimes-funded research project at Yale was recently featured in the media. The research is addressing ciliary motility and the movement of mucus, with the hopes of ultimately reducing lung injury in preterm infants.     Tweet

Acidemia plus hypercapnia increases the risk of IVH

An observational study of extremely low birth weight babies looked at the association between acidemia, hypercapnia and severe intraventricular hemorrhage. Rates of severe IVH were higher in infants with a high base deficit (defined as a median base deficit of…

Safety of sildenafil in infants

The Food and Drug Administration issued a warning in 2012 against the use of sildenafil in pediatric patients (age 1 – 17). To assess safety concerns about sildenafil use  in infants, a review of published literature on this medication was…

Routine bronchoscopy in babies with esophageal atresia

A case series of 88 infants with suspected esophageal atresia (with or without a known tracheo-esophageal fistula) who underwent a laryngotracheobronchoscopy prior to surgical repair describes the findings of this procedure. New findings were discovered in one out of five…

Nasal CPAP after extubation

A randomized trial of preterm babies 500 – 1000 grams birth weight being extubated for the first time compared the use of high (7 – 9 cms) versus low (4 – 6 cms) nasal CPAP levels. Each arm of the…

Preterm infants in adulthood have abnormal ventilatory responses

Preterm infants exposed to hyperoxia have abnormal ventilatory responses to hypoxia and hyperoxia. To determine if such responses persist into adulthood, 13 adults who were born very preterm were tested by exposing them to five minutes of isocapnic, isobaric hypoxia…

Maintaining oxygen saturation within target range

A single-center report describes the results of an effort to maintain oxygen saturation levels within a prespecified target range for VLBW infants, with monitoring of compliance using signal-extraction technology pulse oximetry. The target range for VLBW infants on supplemental oxygen…

Extubating very preterm infants to nasal cannula

In a multicenter trial, infants less than 32 weeks gestation who were being extubated were randomly placed either on nasal CPAP (7 cm water) or on high-flow nasal cannula (5 – 6 liters per minute). The primary outcome was treatment…

Intranasal midazolam for delivery room intubation

A case series from France reports on the use of intranasal midazolam as pre-medication for intubation of preterm infants to administer surfactant soon after birth. Twenty-seven infants with a median gestation of 29 weeks were studied. Infants were monitored using pain…

Stylets for intubation

An unblinded randomized study from Australia compared endotracheal intubations (by residents or fellows in the delivery room or in the NICU) performed with and without a stylet. The overall success rate on the first attempt was between 50 – 60%.…

The stable microbubble test to predict CPAP success

The stable microbubble test (SMT) performed on gastric aspirate in the first hour of life was prospectively studied in 68 infants less than 30 weeks gestation placed on CPAP immediately after birth. The diagnostic test accuracy of the SMT was…

Nasal tube resuscitation of preterm infants

A randomized (unblinded) study compared the effects of resuscitating infants 24 – 29 weeks at birth with either a face mask or a nasal tube to provide positive pressure ventilation. Both these devices were connected to a T-piece resuscitator. Resuscitation…