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Published on: August 15, 2018
Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside
Milena Tana1, Chiara Tirone1, Claudia Aurilia1
1Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Insights
Extremely preterm infants need respiratory support for survival, but it can cause lung injury. Lung-protective ventilation strategies from birth are crucial to minimize bronchopulmonary dysplasia in these vulnerable newborns.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Extremely preterm infants often require respiratory support for successful cardiopulmonary transition after birth.
- Adequate lung inflation and ventilation are critical for newborn survival, as per current resuscitation guidelines.
- Respiratory support, especially mechanical ventilation, is a significant risk factor for bronchopulmonary dysplasia in preterm infants.
Purpose of the Study:
- To provide an evidence-based overview of respiratory management strategies for preterm infants.
- To emphasize the importance of lung-protective ventilation from the delivery room.
- To cover acute and chronic respiratory conditions, including neonatal respiratory distress syndrome and surfactant therapy.
Main Methods:
- A narrative review of articles on preterm infant respiratory assistance was conducted.
- PubMed was utilized as the primary database for literature search.
- The review focuses on respiratory management from the delivery room through the neonatal intensive care unit.
Main Results:
- Preterm infants' lungs are underdeveloped and susceptible to injury from mechanical ventilation.
- The risk of lung injury from invasive ventilation increases with decreasing gestational age.
- Lung-protective ventilation strategies are essential to reduce the incidence of bronchopulmonary dysplasia.
Conclusions:
- Neonatologists must master both invasive and noninvasive respiratory support techniques.
- Implementing lung-protective ventilation from the earliest breaths is vital for preterm infants.
- Comprehensive respiratory management, including surfactant therapy, is key to improving outcomes.
Abstract:
Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn's first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy.
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