Background and Objectives
Respiratory distress syndrome (RDS) and ventilation‐induced lung injury lead to significant morbidity in preterm infants. High‐frequency oscillatory ventilation with ...volume‐guarantee (HFOV‐VG) has been used as a rescue therapy and might lead to lower rates of death and bronchopulmonary dysplasia, especially when using low tidal volumes and high frequencies. The aim of the study was to define HFOV‐VG parameters leading to adequate ventilation in the first 72 h of preterm RDS using a low volume and high‐frequency strategy.
Design and Methods
Retrospective cohort study in a tertiary‐level neonatology unit. Infants <32 weeks with severe respiratory insufficiency needing HFOV‐VG were included. Patients were ventilated following a standard mechanical ventilation aiming for low tidal volumes and high frequencies. Clinical data, perinatal characteristics and high‐frequency parameters corresponding with adequate ventilation were recorded.
Results
116 patients were included. Median gestational age was 25 weeks (interquartile range IQR = 24–27), median birth weight 724 g (IQR = 600–900 g). HFOV‐VG was started at 2 h, median high‐frequency tidal volume was 1.63 ml/kg (IQR = 1.44–1.84) and median frequency was 16 Hz (IQR = 15–18). Weight‐adjusted tidal volumes did not depend on gestational age, antenatal corticosteroids nor chorioamnionitis, and were inversely correlated with frequencies (R
2 = −0.10, p = .001).
Conclusion
HFOV‐VG can reach adequate ventilation at high frequencies when using adequate volumes, providing a feasible ventilation strategy that might be of help in preterm infants with RDS.
Aim
This study assessed the effectiveness of an individualised intervention to reduce parental stress, anxiety and depression in a neonatal intensive care unit (NICU).
Methods
Parents of infants ...admitted to the NICU for a minimum of 4 weeks underwent a five‐step individualised intervention programme delivered by a psychologist.
Results
The study population comprised 40 mothers and 25 fathers in the intervention group and 40 mothers and 29 fathers in the control group who received the standard support. Similar stress levels were observed in both groups before the intervention. However, after 15 days, the group that received the individualised intervention showed a statistically significant lower level of anxiety, with none of the mothers and fathers in the intervention group reporting anxiety, compared with 2.5% of mothers and 10.3% of fathers in the control group. At discharge, 50% of mothers and 80% of fathers in the intervention group reported no level of depression, compared to all the mothers and fathers in the control group.
Conclusion
An intervention programme individualised to the needs of mothers and fathers with infants admitted to a NICU for at least 4 weeks was effective in reducing anxiety and depression compared to the standard care.
The number of infants born preterm including extremely premature babies is rising worldwide, particularly in low- and middle-income countries, which challenge neonatologists and milk banks for the ...provision of the most adequate nutrition for successful infant’s growth and development. The benefits of mother’s own milk (MOM) have been extensively recognized, but the use of donor milk (DM) is a commonly routine practice in preterm neonates admitted to the NICU. Pasteurized mature milk from milk banks is not the same composition than the mother’s colostrum and premature milk, the characteristics of which protect the infant from the risk for necrotizing enterocolitis, late-onset sepsis, and other comorbidities associated with prematurity. The development of a personalized nutrition unit (PNU) allows to obtain DM from mothers who have their infants admitted to the NICU and produce an excess of milk, a practice that matches MOM by gestational age and the stage of lactation, ensuring an adequate composition of DM to target the nutritional requirements of premature infants.
Conclusion
: This narrative review presents salient data of our current knowledge and concerns regarding milk feeding of preterm infants in the NICU, with special emphasis on personalized DM as a result of establishing a PNU.
What is Known:
•
Donor milk bank is mature or pooled milk from lactating mothers at different stages of lactation.
•
Milk composition varies by gestational age and stage of lactation.
What is New:
•
Donor milk from mothers delivered prematurely have the most adequate composition for preterm infant feeding.
•
Personalized nutrition for premature infants with preterm donor milk is feasible.
The authors reviewed the published evidence on the presence of oligosaccharides in human milk (HMO) and their benefits in in vitro and in vivo studies. The still limited data of trials evaluating the ...effect of mainly 2'-fucosyllactose (2'-FL) on the addition of some of HMOs to infant formula were also reviewed. PubMed was searched from January 1990 to April 2018. The amount of HMOs in mother's milk is a dynamic process as it changes over time. Many factors, such as duration of lactation, environmental, and genetic factors, influence the amount of HMOs. HMOs may support immune function development and provide protection against infectious diseases directly through the interaction of the gut epithelial cells or indirectly through the modulation of the gut microbiota, including the stimulation of the bifidobacteria. The limited clinical data suggest that the addition of HMOs to infant formula seems to be safe and well tolerated, inducing a normal growth and suggesting a trend towards health benefits. HMOs are one of the major differences between cow's milk and human milk, and available evidence indicates that these components do have a health promoting benefit. The addition of one or two of these components to infant formula is safe, and brings infant formula closer to human milk. More prospective, randomized trials in infants are need to evaluate the clinical benefit of supplementing infant formula with HMOs.
Background and Objectives
The optimal lung volume strategy during high‐frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in ...oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV‐VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV‐VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure.
Design and Methods
The prospective observational study was done in a tertiary‐level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV‐VG in preterm infants with severe respiratory failure.
Results
Twenty‐seven patients were included, with a median gestational age of 24 weeks (interquartile range IQR: 23–25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2O (IQR: 10–13), median critical lung opening mPaw during recruitment was 14 cm H2O (IRQ: 12–16), and median optimal mPaw was 12 cm H2O (IQR: 10–14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2: 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01).
Conclusion
In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV‐VG.
To study the associated effect of a complete course of antenatal corticosteroids (ACSs) on mortality and morbidity rates among preterm infants in our population.
Observational prospective study of ...infants born at less than 32 weeks' gestation and admitted to our Neonatal Care Unit between January 2012 and December 2018. We analyzed mortality at discharge and respiratory and neurological morbidity, both during hospitalization and at 24 months' postmenstrual age.
The study included a total of 710 patients with a median gestational age of 28.5 weeks (IQR 26.4-30.5) and mean weight of 1.090 g (IQR 800-1.391). Of which, 62.4% received a complete course of antenatal steroids. Given the differences observed in the baseline characteristics of patients who either did or did not receive a full course of antenatal steroids, a propensity score covariate adjustment was performed for all estimations. The effect of ACS therapy differs depending on sex with a positive effect on acute respiratory morbidity and mortality in male patients of less than 29 weeks' gestation. In female infants, there is no significant beneficial association between ACS therapy and mortality or any of the morbidities studied.
In our population of preterm infants, treatment with antenatal steroids is associated with a different effect depending on sex. Antenatal steroids therapy associated with a positive effect in male patients with a gestational age of less than 29 weeks.
Findings from previous meta-analyses of randomized clinical trials (RCTs) in premature infants with respiratory distress syndrome (RDS) varied as to whether clinical outcomes differed by type of ...animal-derived pulmonary surfactant; real-world evidence (RWE) was excluded. We extracted study characteristics and outcomes from full-text articles from a systematic search for studies that compared beractant with poractant alfa for RDS in preterm infants. RWE data were tabulated; RCT data were subjected to meta-analyses. Designs, patient characteristics, and follow-up durations varied widely among studies (4 RWE, 15 RCT). RWE studies with adjusted odds ratios (ORs) found no statistically significant between-treatment differences in outcomes. In RCT meta-analyses, no statistically significant between-treatment differences were observed for death (OR 95% confidence interval, 1.35 0.98-1.86), bronchopulmonary dysplasia (1.25 0.96-1.62), pneumothorax (1.21 0.72-2.05), and air leak syndrome (2.28 0.82-6.39). Collectively, outcomes were similar with beractant and poractant alfa in RWE studies and pooled RCTs.
Lung ultrasound (LUS) has been described as a useful tool in early prognosis of several respiratory diseases of the newborn, especially preterm infant newborns (PTNB) with respiratory distress ...syndrome (RDS), but still, it is not a standard of care in many neonatal units. We have conducted a descriptive, prospective study in a tertiary neonatal unit during 1 year. PTNB less than 35 weeks with respiratory distress at birth on non-invasive ventilation were recruited. A LUS was performed in the first 12 h of life and scored from 6 to 18 points (6 areas, 1 to 3 points each). They were followed until discharge. Main outcomes: need for surfactant treatment. Sixty-four preterm infants, median gestational age 29 weeks. Median LUS score in surfactant group was significantly higher than in no surfactant group (
p
< 0.0001). LUS ROC curve for surfactant treatment shows AUC 0.97 (IC 95% 0.92–1). LUS Odds ratio for surfactant treatment 3.17 (IC 95% 1.36–7.35).
Conclusion
: Early high LUS score correlates with surfactant necessity in preterm infants with respiratory distress at birth.
What is Known:
•
Lung ultrasound (LUS) is a useful tool in determining prognosis of preterm infants with respiratory distress at birth.
What is New:
•
This study adds evidence about LUS and preterm infants with respiratory distress, early predicting surfactant need and mechanical ventilation.
The aim of this study is to compare the clinical outcomes at 24 months postmenstrual age of two populations receiving beractant replacement therapy using less invasive surfactant administration ...(LISA) versus intubation, administration of surfactant, and early extubation (INSURE). Hospital admission requirements, psychomotor development, and respiratory and neurological outcomes were studied.
This was a single-center, retrospective, and descriptive study with a sample of 60 patients (30 for each group) on nasal continuous positive airway pressure during the first 3 days of life, requiring surfactant administration.
We found no significant differences between both groups on psychomotor development and respiratory and neurological outcomes.
Compared to INSURE technique, the administration of surfactant by LISA is feasible and safe and reduces invasive mechanical ventilation exposure with no differences in the follow-up neurodevelopmental and respiratory outcomes at 24 postmenstrual age.
Abstract Background Preterm infants, particularly those with bronchopulmonary dysplasia (BPD), are at risk of lung development problems. Over the last decades, lung protective strategies have been ...used, decreasing the risk of chronic lung disease. Objective To evaluate the pulmonary function test (PFT) of preterm infants born after the introduction of lung protective strategies and to assess perinatal determinants of impaired lung function in this population. Methods A prospective, observational, single‐center study was conducted in the neonatal unit of a high‐complexity hospital. The study included newborns with less than 32 weeks gestational age born between 2012 and 2014, who were followed up until they reach school age. For the main outcome, two groups were stablished: no BPD or grade 1 BPD (no BPD/1) and grade 2 or 3 BPD (BPD 2/3). Results Out of 327 patients, 116 were included. BPD was diagnosed in 49.1% (47), with 50.9% (29) classified as grade 1, 35.1% (20) as grade 2, and 14.0% (8) as grade 3. Mean age at PFT was 8.59 years (SD 0.90). Mean FEV1% was 95.36% (SD 13.21) and FEV1 z‐score −0.36 (SD 1.12); FVC% 97.53% (SD 12.59) and FVC z‐score −0.20 (SD 1.06); FEV1/FVC ratio 85.84% (SD 8.34) and z‐score −0.24 (SD 1.34). When comparing patients with no BPD/1 and BPD 2/3, we observed differences in all pulmonary function parameters, which persisted after adjusting for gestational age. No differences in PFT were observed between patients without BPD and those with grade 1 BPD. Most patients (76.7%, 89) had normal spirometry pattern, with obstructive pattern observed in 12.9% (15), restrictive pattern in 9.5% (11), and mixed pattern in 0.9% (1) of patients. Conclusion Preterm infants with BPD 2/3 showed a decrease in all pulmonary function parameters compared to preterm infants with no BPD/1; an effect that was independent of gestational age. Among patients with BPD who had an altered PFT pattern, the most common pattern was obstructive, followed by restrictive and then, mixed.
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