Related Experiment Video
Updated: Jan 24, 2026
Oleic Acid-Injection in Pigs As a Model for Acute Respiratory Distress Syndrome
Published on: October 26, 2018
Interventions for the Management of Respiratory Distress in Late Preterm and Term Infants Experiencing Delayed
Susan Bedwell1, A Renee Leasure, Theresa L Gibson
1Susan Bedwell, DNP, APRN, CCNS-N, is a board-certified, neonatal critical care clinical nurse specialist with 30 years of neonatal intensive care unit experience. She has been involved in several neonatal research studies including studies on ventilator-associated pneumonia, retinopathy of prematurity, intraventricular hemorrhage, and sibling visits and infection rates in the neonatal intensive care unit. Dr Bedwell has presented her work at more than 25 conferences and has several publications. A. Renee Leasure, PhD, RN, CCRN, is an associate professor at the Fran and Earl Ziegler College of Nursing at the University of Oklahoma Health Sciences Center. She has published several articles and presented her work focused on topics relevant to the practice of critical care nursing locally, nationally, and internationally. Theresa L. Gibson, MSN, MBA, RNC-OB, Theresa L. Gibson, MSN, MBA, RNC-OB, is the director of Women's Services with 20 years of experience in the mother-infant dyad within Women's Services and has been an integral part of quality improvement projects improving outcomes for postpartum hemorrhage, oxytocin (Pitocin) use for inductions, and preventing unnecessary neonatal intensive care unit admissions.
Insights
Continuous positive-airway pressure (CPAP) shows promise for managing respiratory distress in newborns, but more research is needed. Early CPAP may reduce neonatal intensive care unit (NICU) admissions for infants with delayed respiratory transition.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Evidence-Based Practice
Background:
- Delayed respiratory transition is a common issue in late preterm and term infants.
- Mild to moderate respiratory distress requires effective management strategies to prevent neonatal intensive care unit (NICU) admission.
Purpose of the Study:
- To review the best available evidence on interventions for managing mild to moderate respiratory distress in late preterm and term infants.
- To identify interventions that may prevent NICU admission due to delayed respiratory transition.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (EMBASE, MEDLINE, Cochrane, PubMed, CINAHL, Google Scholar).
- Included studies were published in English-language, peer-reviewed journals between 2007 and August 2017.
- Study designs encompassed randomized controlled trials, observational studies, and cohort studies focusing on respiratory interventions.
Main Results:
- Continuous positive-airway pressure (CPAP) and sustained lung inflation were investigated as primary interventions.
- Early or prophylactic CPAP demonstrated potential in reducing NICU admissions for respiratory distress.
- Adrenaline injections showed no significant benefit in preventing respiratory distress.
Conclusions:
- While early or prophylactic CPAP shows promise, a lack of comprehensive safety and efficacy data limits its current widespread use.
- Two trials indicated a significant decrease in NICU admissions with prophylactic CPAP, but these were single-center studies on cesarean-born infants.
- Further multicenter randomized controlled trials are essential to establish the safety and efficacy of CPAP for broader clinical recommendation.
Objectives:
To examine the best available evidence for interventions used to manage mild to moderate respiratory distress in late preterm and term infants experiencing delayed respiratory transition.
Data Sources:
EMBASE, MEDLINE, Cochrane Review, Joanna Briggs, PubMed, CINAHL, and Google Scholar online databases were searched for articles related to delayed respiratory transition. Reference lists were reviewed to identify additional articles for inclusion.
Study Selections:
Randomized, blinded, placebo-controlled, randomized prospective, prospective observational, and retrospective cohort studies published in English-language, peer-reviewed journals between 2007 and August 2017 were reviewed for inclusion. Studies were included if they examined respiratory focused interventions that could potentially prevent admission to the neonatal intensive care unit (NICU) of the term or late preterm infant transitioning to extrauterine life.
Data Extraction:
The CASP tools were utilized for appraisal of individual studies. Data were extracted from the 5 studies included in this review.
Data Synthesis:
In 4 of the 5 studies, prevention of NICU admission was the primary aim. The observational study observed videos of newborn resuscitations and described the effect of early intervention with continuous positive-airway pressure (CPAP) ventilation on prevention of NICU admission for respiratory distress. One randomized controlled trial used adrenaline injections to prevent development of respiratory distress. The 3 remaining randomized controlled trials used prophylactic CPAP or sustained inflation as a method for preventing development of delayed respiratory transition. Three of the 5 studies focused exclusively on cesarean born infants. Among the interventions studied, early or prophylactic CPAP shows the most promise for prevention of NICU admission in late preterm and term infants with mild to moderate respiratory distress.
Conclusion:
The lack of safety and efficacy data for either adrenaline injections or prophylactic CPAP precludes either method for current use in the prevention of respiratory distress for the late preterm or term infant transitioning to extrauterine life. Two randomized trials, both using prophylactic CPAP, had a significant decrease in NICU admissions. Both studies were conducted at a single center and exclusive to infants born by cesarean delivery. A single study using sustained lung inflation showed no significant difference in the need for respiratory support or NICU admission. A single study using adrenaline also showed no benefit to the prevention of respiratory distress related to transition. Further multicenter randomized controlled trials are needed before broad adoption of early or prophylactic CPAP can be recommended.
More Related Videos
07:20Lavage-induced Surfactant Depletion in Pigs As a Model of the Acute Respiratory Distress Syndrome ARDS
Published on: September 7, 2016
08:22The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit
Published on: December 12, 2025
Related Concept Videos
01:31Anatomy of Respiratory System II: Lower Respiratory Tract
The Larynx
It is located between the pharynx and the trachea, acts as a passageway for air, and hosts several critical structures, such as the epiglottis, vocal cords, and glottis. The epiglottis acts as a gateway, guiding food to the...
01:16The Respiratory System
01:29Anatomy of Respiratory System I: Upper Respiratory Tract
Nose and nasal cavity
The nose and nasal cavity represent the main external openings of the respiratory tract....
01:23Overview of Respiratory System
What is the Respiratory System?
The respiratory system consists of a series of organs responsible for taking in oxygen and expelling carbon dioxide. The primary function of the respiratory system is to...
01:15Respiratory Volumes
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
01:24Respiratory Capacities
One key metric is the Inspiratory Capacity (IC), which represents the maximum amount of air that can be inhaled with full effort. IC is calculated by summing the tidal volume and inspiratory reserve volume, typically ranging from 2.4 to 3.6 liters.
The Functional Residual Capacity (FRC) represents the air in the...