Respiratory support strategies for the preterm newborn - National survey 2008.
BACKGROUND
Respiratory support strategies for the preterm newborn have been the subject of intense research.


OBJECTIVE
To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials.


METHODS
Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators, modes of ventilation, lung function monitoring, use of exogenous surfactant, oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn.


RESULTS
There was a 94% response rate. Draeger babylog was the most frequently used ventilator in neonates. Twelve (41%) units prefer to use early nasal continuous positive airway pressure (NCPAP) whenever possible. Triggered ventilation is the choice of invasive ventilation in 24 (83%) units (SIMV, SIPPV, PSV); four (14%) units have high frequency oscillation ventilation. SIMV is the most frequent (n=13, 45%) weaning mode. Exogenous surfactant is used as prophylactic in 12 (41%) units. All units use lung function measurements to aid choice of ventilator settings and five (17%) units monitor PaCO2 (transcutaneous = 3; capnometry = 2). Seventeen (59%) units allow oxygen saturation levels from 90% to 95% in infants with respiratory distress syndrome and 15 (52%) levels from 85% to 90% in infants with chronic lung disease. Prevalence of chronic lung disease of prematurity ranged from 0% to 75% (median: 10).


CONCLUSIONS
Many respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials. More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs, the use of SIPPV as the main weaning mode, the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence-based practice.
Serviço de Neonatologia, Hospital de São João, Porto. gusrocha@oninet.pt
Gustavo
G
Rocha
Joana
J
Saldanha
Israel
I
Macedo
Augusta
A
Areias
D002908:Chronic Disease; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008171:Lung Diseases / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D011795:Surveys and Questionnaires