Metered-dose inhaler therapy with spacers: Are newborns capable of using this system correctly?
Carolina Herbes1, Amanda Machado Gonçalves1, Gabriela Cantori Motta2
1Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
Insights
Most newborns cannot generate enough negative pressure for metered-dose inhaler (MDI) aerosol therapy with a spacer and mask. This challenges effective treatment for premature infants with chronic lung disease, requiring further investigation into alternative methods.
Area of Science:
- Neonatal respiratory care
- Pediatric pulmonology
- Pharmacological delivery systems
Background:
- Metered-dose inhaler (MDI) with spacer is standard for chronic lung disease in premature infants.
- Current MDI use in neonates relies on data from other age groups.
- Effective aerosol delivery is crucial for long-term patient stability.
Purpose of the Study:
- To evaluate if newborns can generate sufficient negative inspiratory pressure for MDI-spacer-mask aerosol therapy.
Main Methods:
- 117 healthy newborns (12-48 hours old) participated.
- Inspiratory pressure was measured using a respiratory pressure meter connected to the spacer.
- Three 10-second measurements were taken per participant.
Main Results:
- Only 36.8% of newborns generated adequate negative pressure to open the spacer valve.
- 25 participants met the criteria in all three measurements.
- No association found between negative pressure generation and weight, gestational age, or delivery mode.
Conclusions:
- Most neonates cannot generate adequate negative inspiratory pressure for MDI-spacer-mask therapy.
- This significantly impacts the efficacy of aerosol delivery in this population.
- Alternative or modified MDI delivery systems may be needed for neonates.
Introduction:
Aerosol therapy using a metered-dose inhaler (MDI) coupled to a spacer chamber is the most widely used long-term treatment modality for chronic lung disease of prematurity. However, its use in neonates is based on data obtained from other age groups. Proper use of maintenance treatment is essential for the long-term stability of these patients.
Objective:
To ascertain whether newborns are capable of generating negative pressure during the use of a spacer with face mask for aerosol therapy.
Patients And Methods:
Total of 117 low-risk newborns (age 12-48 hours), with no congenital malformations or any detectable clinical symptoms, were included. Inspiratory pressure was measured with a respiratory pressure meter, at each respiratory cycle, during a 10-second period, for three sequential measurements. The meter was connected to the inner chamber of the spacer through a noncollapsible silicone tube. Suitably sized masks were used.
Results:
Only 43 participants (36.8%) generated a negative pressure capable of opening the spacer valve, as verified by the respiratory pressure meter. In 25 patients, all three measurements were within the expected range. Weight, gestational age, and mode of delivery were in no way associated with the ability to generate a detectable negative pressure.
Conclusion:
In neonates, the MDI therapy with a spacer chamber and face mask is susceptible to failure due to the inability of most patients in this age range to generate a negative inspiratory pressure sufficient to open the spacer valve.
Related Concept Videos
01:23Inhaled Medications
01:15Distance Corrections
01:20Power Factor Correction
01:24Pulmonary Ventilation: Inhalation
Boyle's law becomes particularly pertinent when examining respiratory...
01:21Dose Size and Dosing Frequency: Determination Methods
01:20Inhalational Anesthetics: Overview