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Ventilation, oxidative stress and risk of brain injury in preterm newborn

Laura Cannavò1, Immacolata Rulli2, Raffaele Falsaperla3

  • 1Department of Human Pathology of Adulthood and Childhood, University of Messina, UOC di Pediatria, Pad. NI, 3° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy. laura_cannavo@hotmail.it.

Italian Journal of Pediatrics
|July 25, 2020
PubMed

Insights

Protecting preterm infants from brain injury requires gentle respiratory support. Minimizing lung injury from ventilation (VILI) involves using low oxygen levels, non-invasive methods, and controlled pressure and volume settings.

Area of Science:

  • Neonatal Medicine
  • Pediatric Neurology
  • Respiratory Physiology

Background:

  • Preterm infants face higher risks of cognitive deficits, behavioral issues, and cerebral palsy.
  • Mechanical ventilation, often necessary for premature infants before 32 weeks gestation, can cause brain injury via oxidative stress, inflammation, and hemodynamic instability.
  • Key VILI triggers include oxygen toxicity, barotrauma, and volutrauma, leading to pro-inflammatory cytokine release.

Purpose of the Study:

  • To review the mechanisms of ventilation-induced lung injury (VILI).
  • To explore the link between VILI and brain injury in preterm neonates.
  • To inform strategies for optimizing respiratory support in premature infants.

Main Methods:

  • Literature review analyzing VILI mechanisms.
  • Examination of pathways linking lung injury to brain damage.
  • Synthesis of current recommendations for respiratory support.

Main Results:

  • Ventilation can induce brain damage through localized cerebral inflammation and hemodynamic instability.
  • Oxygen toxicity, barotrauma, and volutrauma are primary drivers of VILI and subsequent brain injury.
  • Gentle ventilation strategies are crucial for mitigating these risks.

Conclusions:

  • Implementing gentle ventilation from the delivery room is essential to reduce VILI and associated brain injury.
  • Recommended initial settings include 21-30% oxygen, prioritizing non-invasive respiratory support.
  • If mechanical ventilation is necessary, low Positive End-Expiratory Pressure (PEEP) and tidal volumes are advised.

Keywords:
Brain injuryOxidative stressPretermVentilation

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