Am J Perinatol 2019; 36(S 02): S115-S119
DOI: 10.1055/s-0039-1692134
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Recruitment Strategy in Preterm Neonates < 29 Weeks of Gestational Age to Reduce the Need for Intubation in the Delivery Room

Flavia Petrillo
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
,
Luigia Valenzano
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
,
Caterina Franco
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
,
Giovanna Calò
2   Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
,
Domenico Dentico
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
,
Paolo Manzoni
3   Division of Neonatology and NICU, S. Anna Obstetrics and Neonatology Hospital, Torino, Italy
,
Gabriele D'Amato
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
,
Antonio Del Vecchio
1   Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
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Publikationsverlauf

Publikationsdatum:
25. Juni 2019 (online)

Abstract

Background The application of noninvasive ventilation (NIV) modalities from birth in the delivery room (DR) during fetal–neonatal transition reduces the need for invasive mechanical ventilation, mortality, and bronchopulmonary dysplasia (BPD). The use of a RAM nasal cannula (RAM NC) in the DR for resuscitation results in less need for intubation, chest compressions, and epinephrine administration when compared with using a face mask for PPV in the DR.

Objective To evaluate the need for endotracheal intubation in the DR among extremely low gestational age neonates treated at birth with sustained inflation (SI) followed by a nasal continuous positive airway pressure (NCPAP) (range: 6–8 cm of H2O) delivered through the RAM NC.

Study Design A retrospective study was conducted to compare the use of NIV techniques in the DR and the need for intubation in the DR in premature infants 23 to 28 weeks' gestational age from December 2016 to July 2018 (group A). These data were compared with those of premature inborn infants with similar GA born between April 2015 and November 2016 (group B). In the DR, immediately after birth, neonates in group A received SI through RAM NC followed by CPAP ranging from 6 to 8 cm H2O, whereas the neonates in group B were treated in the DR with SI administered through a face mask followed by the application of CPAP of 5 cm H2O delivered through a nasopharyngeal tube.

Results A total of 65 preterm infants 23 to 28 weeks of gestational age, 31 in group A and 34 in group B, were included in the study. The percentage of neonates intubated in the DR was significantly lower in group A (p < 0.008). In both groups, no neonates died in the DR, and no one required epinephrine and/or chest compressions. For those neonates who did not require intubation in the DR, there was no significant difference in the average FiO2 on arrival in the neonatal intensive care unit, rate of intubation within 24 hours, and use of surfactant. The incidence of BPD was similar in the two groups. Only one infant in group A developed moderate BPD, and no one needed oxygen and/or ventilatory assistance at discharge. Mortality was similar in the two groups, with a slight prevalence in group B (27.7 vs. 19.2%).

Conclusion SI with RAM NC followed by NCPAP ranging from 6 to 8 cm H2O, administered with RAM NC resulted in a significant reduction of intubation in the DR.

 
  • References

  • 1 Barton SK, Tolcos M, Miller SL. , et al. Unraveling the links between the initiation of ventilation and brain injury in preterm infants. Front Pediatr 2015; 3: 97
  • 2 Dargaville PA, Tingay DG. Lung protective ventilation in extremely preterm infants. J Paediatr Child Health 2012; 48 (09) 740-746
  • 3 Schmölzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 2013; 347: f5980
  • 4 Templin L, Grosse C, Andres V. , et al. A quality improvement initiative to reduce the need for mechanical ventilation in extremely low gestational age neonates. Am J Perinatol 2017; 34 (08) 759-764
  • 5 Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr 2012; 101 (12) 1232-1239
  • 6 Lista G, Maturana A, Moya FR. Achieving and maintaining lung volume in the preterm infant: from the first breath to the NICU. Eur J Pediatr 2017; 176 (10) 1287-1293
  • 7 Paz P, Ramanathan R, Hernandez R, Biniwale M. Neonatal resuscitation using a nasal cannula: a single-center experience. Am J Perinatol 2014; 31 (12) 1031-1036
  • 8 Biniwale M, Wertheimer F. Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants. Resuscitation 2017; 116: 33-38
  • 9 Lista G, Boni L, Scopesi F. , et al; SLI Trial Investigators. Sustained lung inflation at birth for preterm infants: a randomized clinical trial. Pediatrics 2015; 135 (02) e457 –e464
  • 10 Dekker J, Hooper SB, van Vonderen JJ, Witlox RSGM, Lopriore E, Te Pas AB. Caffeine to improve breathing effort of preterm infants at birth: a randomized controlled trial. Pediatr Res 2017; 82 (02) 290-296
  • 11 Vento G, Pastorino R, Boni L. , et al. Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - “IN-REC-SUR-E” - in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial. Trials 2016; 17: 414
  • 12 Sweet DG, Carnielli V, Greisen G. , et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update. Neonatology 2017; 111 (02) 107-125
  • 13 Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015; 95: 249-263
  • 14 Hooper SB, Te Pas AB, Kitchen MJ. Respiratory transition in the newborn: a three-phase process. Arch Dis Child Fetal Neonatal Ed 2016; 101 (03) F266 –F271
  • 15 Finer NN, Rich W, Wang C, Leone T. Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation. Pediatrics 2009; 123 (03) 865-869
  • 16 Schmölzer GM, Dawson JA, Kamlin CO, O'Donnell CP, Morley CJ, Davis PG. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed 2011; 96 (04) F254-F257
  • 17 Capasso L, Capasso A, Raimondi F, Vendemmia M, Araimo G, Paludetto R. A randomized trial comparing oxygen delivery on intermittent positive pressure with nasal cannulae versus facial mask in neonatal primary resuscitation. Acta Paediatr 2005; 94 (02) 197-200