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Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
E E Foglia1,2, E A Jensen1,2, H Kirpalani1,2
1Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Preventing bronchopulmonary dysplasia (BPD) in preterm infants involves early respiratory support. Continuous positive airway pressure (CPAP) and timely surfactant therapy are key interventions during neonatal transition.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is the most frequent chronic respiratory condition in premature infants.
- Preterm infants face a high risk of acute lung injury post-birth, increasing BPD susceptibility.
Purpose of the Study:
- To review current evidence on interventions during neonatal transition to prevent BPD in extremely preterm infants.
- To evaluate the efficacy of delivery room and early postnatal interventions.
Main Methods:
- Review of current evidence on interventions during neonatal transition.
- Analysis of continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen, and surfactant therapy.
Main Results:
- Stabilization with CPAP in the delivery room is recommended, with mechanical ventilation reserved for non-invasive support failures.
- Early surfactant administration (<2 hours of life) is advised for intubated infants.
- Prudent titration of supplemental oxygen to achieve targeted saturations is recommended.
Conclusions:
- Non-invasive respiratory support, particularly CPAP, should be prioritized for preterm infants.
- Early surfactant therapy and targeted oxygenation are crucial for preventing BPD.
- Sustained inflation and non-invasive surfactant administration show promise but require further investigation.
Abstract:
Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (delivery room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the delivery room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (<2 h of life). We recommend prudent titration of supplemental oxygen in the delivery room to achieve targeted oxygen saturations. Promising interventions that may further reduce BPD, such as sustained inflation and non-invasive surfactant administration, are currently under investigation.
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