Neonatal respiratory support strategies-short and long-term respiratory outcomes

Ourania Kaltsogianni; Theodore Dassios; Anne Greenough

doi:10.3389/fped.2023.1212074

Neonatal respiratory support strategies-short and long-term respiratory outcomes

Front Pediatr. 2023 Jul 26:11:1212074. doi: 10.3389/fped.2023.1212074. eCollection 2023.

Authors

Ourania Kaltsogianni¹, Theodore Dassios^{1

2}, Anne Greenough¹

Affiliations

¹ Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
² Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom.

Abstract

Mechanical ventilation (MV), although life-saving, is associated with chronic respiratory morbidity in both preterm and term born infants. New ventilation modes have been developed with the aim of minimising lung injury. These include invasive and non-invasive respiratory support strategies, techniques for less invasive surfactant administration (LISA) and closed-loop automated oxygen control (CLAC) systems. Increasingly, newborn infants with signs of respiratory distress are stabilised on continuous positive airway pressure (CPAP) and receive LISA. Early CPAP when compared to mechanical ventilation reduced the incidence of BPD and respiratory morbidity at 18 to 22 months corrected age. Nasal intermittent positive pressure ventilation reduced treatment failure rates compared to CPAP, but not bronchopulmonary dysplasia (BPD). LISA compared with intubation and surfactant delivery reduced BPD, but there is no evidence from randomised trials regarding long-term respiratory and neurodevelopmental outcomes. Synchronisation of positive pressure inflations with the infant's respiratory efforts used with volume targeting should be applied for infants requiring intubation as this strategy reduces BPD. A large RCT with long term follow up data demonstrated that prophylactic high frequency oscillatory ventilation (HFOV) improved respiratory and functional outcomes at school age, but those effects were not maintained after puberty. CLAC systems appear promising, but their effect on long term clinical outcomes has not yet been explored in randomised trials. Further studies are required to determine the role of newer ventilation modes such as neurally adjusted ventilator assist (NAVA). All such respiratory support strategies should be tested in randomised controlled trials powered to assess long-term outcomes.

Keywords: closed loop automated oxygen control; continuous positive airway pressure; less invasive surfactant administration; long term outcomes; mechanical ventilation; non-invasive ventilation.

Publication types

Review

Grants and funding

This project was partially funded by King's College London 2018 Medical Research Council Confidence in Concept Award through the King's Health Partners' Research and Development Challenge Fund.”