Techniques of early respiratory management of very low and extremely low birth weight infants.
The generalized anatomic and physiologic immaturity of preterm infants of very low birth weight (VLBW) (<or=1,500 g) and extremely low birth weight (ELBW) (<or=1,000 g) places them at high risk for death or associated negative sequelae, including chronic lung disease of infancy (CLDI). The standard treatment for pulmonary immaturity, mechanical ventilation (MV) at birth, can lead to barotrauma, volutrauma, pulmonary edema, infection, and inflammation. To minimize these negative outcomes, multiple treatment strategies have been proposed and evaluated as to their subsequent clinical course. This article compares, contrasts, and integrates the use of MV, nasal continuous positive airway pressure (NCPAP), and surfactant administration to encourage and support consideration of their use in the VLBW and ELBW population. Supporting a reduction of the use of MV in favor of NCPAP is safe and recommended because this practice is likely to decrease the probable sequelae of CLDI while permitting an individualized approach.
Miller
Nichole E
NE
University of Minnesota Amplatz Children's Hospital, Minneapolis, MN 55454, USA. nmiller5@fairview.org
D001997:Bronchopulmonary Dysplasia / Q000451:nursing; D045422:Continuous Positive Airway Pressure / Q000451:nursing*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010102:Oxygen Inhalation Therapy / Q000451:nursing*; D011379:Prognosis; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000451:nursing*; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000451:nursing*; D015996:Survival Rate
D011663:Pulmonary Surfactants