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Published on: November 19, 2015
Respiratory muscle function in the newborn: a narrative review
Theodore Dassios1,2, Aggeliki Vervenioti3, Gabriel Dimitriou3
1Department of Women and Children's Health, King's College London, London, UK. theodore.dassios@kcl.ac.uk.
Insights
Assessing newborn respiratory muscle function is crucial, especially for premature infants. New methods like diaphragmatic ultrasound and neurally adjusted ventilator assist show promise for clinical applications.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Diagnostic Imaging
Background:
- Respiratory muscles, primarily the diaphragm, are vital for breathing in newborns.
- Newborns, particularly premature infants, are susceptible to diaphragmatic dysfunction due to physiological immaturity.
- Factors like congenital anomalies and infections can impair respiratory muscle function.
Purpose of the Study:
- To review current evidence and methods for assessing respiratory muscle function in newborns.
- To explore the clinical applications of these assessment methods.
- To highlight recent technological advancements in the field.
Main Methods:
- Review of existing literature on respiratory muscle function assessment in neonates.
- Inclusion of methods such as electromyography, maximal respiratory pressures, and thoraco-abdominal asynchrony.
- Emphasis on emerging techniques like bedside ultrasonography and neurally adjusted ventilator assist.
Main Results:
- Respiratory muscle function is often impaired in premature neonates and those with congenital anomalies.
- Prolonged mechanical ventilation, hypoxia, hypercapnia, and infections negatively impact respiratory muscle function.
- Caffeine and synchronized/volume-targeted ventilation positively influence respiratory muscle function.
Conclusions:
- Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist represent significant advancements.
- These novel technologies offer substantial clinical applicability for managing respiratory function in newborns.
- Optimizing respiratory support and utilizing adjunct therapies like caffeine are key to improving outcomes.
Abstract:
Our aim was to summarise the current evidence and methods used to assess respiratory muscle function in the newborn, focusing on current and future potential clinical applications. The respiratory muscles undertake the work of breathing and consist mainly of the diaphragm, which in the newborn is prone to dysfunction due to lower muscle mass, flattened shape and decreased content of fatigue-resistant muscle fibres. Premature infants are prone to diaphragmatic dysfunction due to limited reserves and limited capacity to generate force and avoid fatigue. Methods to assess the respiratory muscles in the newborn include electromyography, maximal respiratory pressures, assessment for thoraco-abdominal asynchrony and composite indices, such as the pressure-time product and the tension time index. Recently, there has been significant interest and a growing body of research in assessing respiratory muscle function using bedside ultrasonography. Neurally adjusted ventilator assist is a novel ventilation mode, where the level of the respiratory support is determined by the diaphragmatic electrical activity. Prolonged mechanical ventilation, hypercapnia and hypoxia, congenital anomalies and systemic or respiratory infection can negatively impact respiratory muscle function in the newborn, while caffeine and synchronised or volume-targeted ventilation have a positive effect on respiratory muscle function compared to conventional, non-triggered or pressure-limited ventilation, respectively. IMPACT: Respiratory muscle function is impaired in prematurely born neonates and infants with congenital anomalies, such as congenital diaphragmatic hernia. Respiratory muscle function is negatively affected by prolonged ventilation and infection and positively affected by caffeine and synchronised compared to non-synchronised ventilation modes. Point-of-care diaphragmatic ultrasound and neurally adjusted ventilator assist are recent diagnostic and therapeutic technological developments with significant clinical applicability.
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