NO for preterm infants at risk of bronchopulmonary dysplasia
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33101, USA.The Lancet (Impact Factor: 45.22). 07/2010; 376(9738):308-10. DOI: 10.1016/S0140-6736(10)61051-3
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ABSTRACT: When asked to address the above question, findings that appeared to be among the most relevant included (1) interventions in the delivery room directed at supporting the physiological transition from intrauterine to extrauterine life rather than actively intervening in it; (2) recent data suggesting that keeping extremely low-gestational age neonates at a pulse oximeter saturation (SpO(2)) of 91-95% would increase their chances of survival compared with aiming for lower SpO(2) values; (3) using caffeine citrate in infants <1250 g with apnoea of prematurity improves neurodevelopmental outcome; (4) injecting antivascular epithelial growth factor into the vitreous seems to be an effective treatment for retinopathy of prematurity and (5) moderate hypothermia for perinatal hypoxic-ischaemic encephalopathy increases the likelihood of survival without neurological impairment. Here, data that support these recent changes in approach will be presented and discussed.
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ABSTRACT: The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five decades. Landmark discoveries are described in their historical context and underlying theories of lung protection are discussed. The review finishes by integrating different approaches and perspectives into a state-of-the-art concept for lung-protective ventilation in this fragile patient population. Improvements in neonatal respiratory support in the 1970s and 1980s have contributed to dramatic improvements of mortality and morbidity rates among neonates with respiratory failure. Continuous positive airway pressure, antenatal corticosteroids and surfactant replacement therapy revolutionized the care of preterm infants. With the recognition that atelectrauma, volutrauma and oxygen toxicity are the main factors contributing to ventilator-induced lung injury, lung-protective strategies, including noninvasive respiratory support, tidal volume targeting during conventional mechanical ventilation and high frequency ventilation were developed in the 1990s. Given the fact that progress made in the last decade has only resulted in minor improvements in mortality and morbidity rates of neonates with respiratory failure, it seems unlikely that further refinements of current technologies will produce giant leaps forward in high-resource countries. It appears that entirely new approaches would be required. In contrast, knowledge and technology transfer of basic respiratory support strategies (e.g. use of oxygen, simple systems to provide continuous positive airway pressure), could have an enormous impact on the prognosis of neonates with respiratory failure in low-resource countries. © 2013 S. Karger AG, Basel.
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