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Restricted Ventilation Associated with Reduced Neurodevelopmental Impairment in Preterm Infants

Roseanne J S Vliegenthart1, Wes Onland, Aleid G van Wassenaer-Leemhuis

  • 1Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

Neonatology
|June 12, 2017
PubMed

Insights

Restricting invasive mechanical ventilation for preterm infants is feasible and may reduce the combined risk of death or neurodevelopmental impairment. This approach shows promise for improving outcomes in extremely premature babies.

Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Bronchopulmonary dysplasia (BPD) is a risk associated with invasive mechanical ventilation (IMV) in preterm infants.
  • Optimizing respiratory support strategies is crucial for improving outcomes in extremely premature neonates.
  • Neurodevelopmental impairment (NDI) is a significant concern in survivors of preterm birth.

Purpose of the Study:

  • To evaluate the impact of a restrictive invasive mechanical ventilation (IMV) policy on neurodevelopmental impairment (NDI) at 24 months corrected age (CA).
  • To assess the feasibility and outcomes associated with reduced IMV use in preterm infants.
  • To compare the incidence of BPD and NDI between two epochs with different ventilation strategies.

Main Methods:

  • Retrospective cohort study of preterm infants (gestational age <30 weeks) born in two distinct periods (2004/2005 vs. 2010/2011).
  • Epoch 2 implemented a policy of restricted IMV and increased use of noninvasive respiratory support and stimulants.
  • Data collected included patient characteristics, respiratory management, BPD, mortality, and NDI at 24 months' CA.

Main Results:

  • Infants in the restricted IMV epoch (epoch 2) had significantly less intubation and shorter IMV duration.
  • Use of noninvasive therapies like caffeine, doxapram, and nasal ventilation increased in epoch 2.
  • The combined outcome of death or NDI at 24 months' CA was significantly lower in epoch 2 (24.7%) compared to epoch 1 (33.9%).

Conclusions:

  • A restrictive approach to IMV in preterm infants is achievable.
  • Restricted IMV may be associated with a reduced risk of combined death or NDI at 24 months' CA.
  • Further research is warranted to validate these findings in larger cohorts.
Abstract

Keywords:
Bronchopulmonary dysplasiaInvasive mechanical ventilationNeurodevelopmental impairment

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