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Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
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Relationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants

Anoop Pahuja1, Katie Hunt2,3, Vadivelam Murthy2,3

  • 1Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.

European Journal of Pediatrics
|August 2, 2018
PubMed

Insights

High expiratory tidal volumes and low end-tidal carbon dioxide during resuscitation in premature infants are linked to intraventricular hemorrhage (IVH). Avoiding these may reduce IVH development in neonates.

Area of Science:

  • Neonatalogy
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD) are significant complications in premature infants.
  • Previous research suggests a link between hypocarbia and IVH/BPD development in neonates.

Purpose of the Study:

  • To investigate the association between respiratory parameters during delivery suite resuscitation and the development of IVH and BPD in preterm infants.
  • To test the hypothesis that high expiratory tidal volumes (VTE) and/or low end-tidal carbon dioxide (ETCO2) levels during resuscitation predict IVH or BPD.

Main Methods:

  • Respiratory function monitoring was used to record expiratory tidal volumes (VTE) and end-tidal carbon dioxide (ETCO2) during resuscitation in 70 preterm infants (median gestational age 27 weeks).
  • Infants were assessed for the development of IVH and BPD, with analysis of over 31,000 inflations.
  • Statistical analysis compared respiratory parameters between infants who developed IVH/BPD and those who did not, controlling for gestational age and birth weight.

Main Results:

  • Infants who developed IVH had a significantly higher number of inflations with high VTE (>6 ml/kg) and low ETCO2 (<4.5 kPa) compared to those without IVH, even after adjusting for confounders (p=0.019).
  • No significant differences in VTE or ETCO2 were found between infants who developed BPD and those who did not, after adjustment.
  • There were no significant differences in resuscitation duration or hyperoxia between the groups.

Conclusions:

  • Avoiding high tidal volumes and hypocarbia during delivery suite resuscitation may be a strategy to reduce the incidence of intraventricular hemorrhage in preterm infants.
  • The findings highlight the potential impact of initial respiratory support on neonatal outcomes, specifically IVH.

Keywords:
Bronchopulmonary dysplasiaIntraventricular haemorrhagePrematurityResuscitation

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