Optimal Conventional Mechanical Ventilation in Full-Term Newborns: A Systematic Review

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Most research on mechanical ventilation strategies focuses on premature infants with respiratory distress syndrome.
• Evidence for optimal ventilation in full-term newborns is limited.
• This review addresses the gap in knowledge regarding mechanical ventilation for term infants.

Purpose of the Study:

• To systematically review and synthesize existing evidence on mechanical ventilation strategies specifically for full-term newborns.
• To identify optimal ventilation parameters and approaches for term infants.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Comprehensive literature search across major databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) from 1996-2017.
• Inclusion of randomized controlled trials, intervention, and crossover studies focusing on term newborns (37-42 weeks gestation) and relevant respiratory outcomes.

Main Results:

• No studies exclusively focused on term newborns (37-42 weeks gestation).
• Eight studies met inclusion criteria, but all included mixed populations of premature and term infants.
• Evidence specifically tailored to term newborns is scarce, precluding meta-analysis due to heterogeneity.

Conclusions:

• Synchronized intermittent mandatory ventilation (SIMV) with a tidal volume of 6 mL/kg and positive end-expiratory pressure (PEEP) of 8 cm H2O may offer advantages for term newborns.
• A significant need exists for high-quality, preferably randomized controlled trials, in term newborns requiring mechanical ventilation to optimize respiratory support and outcomes.