Studies suggest that giving newly born preterm infants sustained lung inflation (SLI) may decrease their need for mechanical ventilation (MV) and improve their respiratory outcomes.
We randomly ...assigned infants born at 25 weeks 0 days to 28 weeks 6 days of gestation to receive SLI (25 cm H2O for 15 seconds) followed by nasal continuous positive airway pressure (nCPAP) or nCPAP alone in the delivery room. SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator. The primary end point was the need for MV in the first 72 hours of life. The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia (BPD).
A total of 148 infants were enrolled in the SLI group and 143 in the control group. Significantly fewer infants were ventilated in the first 72 hours of life in the SLI group (79 of 148 53%) than in the control group (93 of 143 65%); unadjusted odds ratio: 0.62 95% confidence interval: 0.38-0.99; P = .04). The need for respiratory support and survival without BPD did not differ between the groups. Pneumothorax occurred in 1% (n = 2) of infants in the control group compared with 6% (n = 9) in the SLI group, with an unadjusted odds ratio of 4.57 (95% confidence interval: 0.97-21.50; P = .06).
SLI followed by nCPAP in the delivery room decreased the need for MV in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD.
This paper examines critical aspects of sensors and measurement instruments used in the clinical care of mechanically ventilated newborn babies. The key variables for ventilator control are described ...and sensors for gas flow and volume are evaluated. The continuous real-time monitoring of critical physical and chemical variables can provide important data that can be used to optimize mechanical ventilator parameters. The options for invasive and noninvasive measurement approaches are introduced and issues relating to the trade-offs between measurement precision and accuracy and patient safety are discussed. Sensors for blood gases, hemodynamic variables, pulmonary mechanics parameters, and ventilator characteristics are described. Accurate gas flow sensors are needed for the effective delivery of an optimized ventilator therapy; the hot-wire anemometer and the pneumotachograph are evaluated. A preliminary study to develop a rationale based on artificial intelligence decision trees for choosing sensors and instruments is presented.
This paper presents a review of medical and biological applications of optical fibres, which span a wide range from light-pipes and pressure or displacement sensors through to complex chemical ...sensors. Coherent fibre bundles are needed for endoscopic imaging whilst single fibres may be used in both near infrared tomography and optical coherence tomography. Delivery of light to tissues, for example to activate targeted chemo-therapeutic agents (PDT), is also achieved conveniently with fibres. Chemical sensing can simply be achieved by transporting light to and from a measurement site with a plain fibre light guide for spectrophotometric or fluorimetry analysis. A further family of fibre-optic chemical sensors has either surface attached molecular recognition sites or a reaction chamber for achieving specific molecular detection. These chemical sensors may be based on the principles of surface plasmon resonance, interferometry, spectrophotometry or fluorimetry. Biological recognition with enzymes or antigen-antibody binding are used to achieve high specificity. The range of potential target molecules has increased rapidly over recent years from simple gases and ions through to large molecules such as DNA.
Abstract Preterm birth is a significant problem in the world regarding perinatal mortality and morbidity in the long term, especially bronchopulmonary dysplasia (BPD). Premature delivery is often ...associated to failure in transition to create an early functional residual capacity (FRC), since many preterm babies need frequently respiratory support. The first and most effective preventive measure to reduce the incidence of BPD is represented by the attempt to avoid preterm birth. Whenever this fails, the prevention of every known risk factors for BPD should start in the delivery room and should be maintained in the NICU through the use of tailored management of high-risk infants.
Some studies have suggested that the early sustained lung inflation (SLI) procedure is effective in decreasing the need for mechanical ventilation (MV) and improving respiratory outcome in preterm ...infants. We planned the present randomized controlled trial to confirm or refute these findings.
In this study, 276 infants born at 25(+0) to 28(+6) weeks' gestation at high risk of respiratory distress syndrome (RDS) will be randomized to receive the SLI maneuver (25 cmH2O for 15 seconds) followed by nasal continuous positive airway pressure (NCPAP) or NCPAP alone in the delivery room. SLI and NCPAP will be delivered using a neonatal mask and a T-piece ventilator.The primary endpoint is the need for MV in the first 72 hours of life. The secondary endpoints include the need and duration of respiratory support (NCPAP, MV and surfactant), and the occurrence of bronchopulmonary dysplasia (BPD).
NCT01440868.
Abstract There is not a conclusive role of Sustained Lung Inflation (SLI) in the management of preterm infants at risk for RDS in the delivery room. This strategy would permit lung recruitment ...immediately after birth through delivery of brief peak pressure to the infant airways via a nasopharyngeal tube or mask allowing preterm infants to achieve FRC and reduce need of mechanical ventilation. We planned in Italy a randomized controlled trial (RCT) to confirm or refute these findings.
Effects of early surfactant administration to premature newborns have been widely investigated in several RCTs. Furthermore, recent studies and metanalysis have compared early with delayed ...administration as well as selective and prophylactic use of surfactant. These data from the literature are discussed in the present review together with the factors that may argue against the standardization of respiratory care at birth. A tailored approach based on the stratification of risk factors may be appropriate in the so heterogeneous population of premature newborns.
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