title: Transitional hemodynamics in preterm infants with a respiratory management strategy directed at avoidance of mechanical ventilation.
abstract: BACKGROUND
  Early respiratory management of very low birth weight infants has changed over recent years to a practice of early use of CPAP with early selective surfactant administration, and decreased use of mechanical ventilation. One strategy is to use the combination of surfactant and prompt extubation to nasal continuous positive airway pressure (INtubate, SURfactant, Extubate, or INSURE). The aim of this study is to describe blood flow and ductal flow in a prospective cohort during the transitional period when this respiratory management strategy is used.
  
  
  METHODS
  Inborn infants <29week gestation underwent INSURE within 30min of birth using 200mg/kg Curosurf. Blood pressure and blood flow parameters (RVO, LVO, SVC flow, ductus arteriosus) were measured at 6, 24 and 72h of age and information on morbidity was collected.
  
  
  RESULTS
  Sixty-eight infants with a median (range) weight of 940 (450-1380) g were studied. 13 (19%) patients needed mechanical ventilation within 72h of life (INSURE failure). Blood flows and blood pressure were within reported ranges. Eleven (16%) patients had a blood pressure <gestational age and 9 (13%) patients had low blood flow.
  
  
  CONCLUSIONS
  These data show a low prevalence of low blood pressure and low blood flow in the first 3days after INSURE as compared to cohorts where mechanical ventilation was preferred during transition. We speculate that altered ventilation strategies have helped decrease the incidence of low blood flow and low blood pressure.
authors.affiliation: Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle NSW, Australia; University of Newcastle, Newcastle, Australia.
authors.forename: Anil
authors.initials: A
authors.lastname: Lakkundi
authors.affiliation: Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle NSW, Australia; University of Newcastle, Newcastle, Australia; University of Wollongong, Wollongong, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Wright
authors.affiliation: Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle NSW, Australia; University of Newcastle, Newcastle, Australia. Electronic address: koert.dewaal@hnehealth.nsw.gov.au.
authors.forename: Koert
authors.initials: K
authors.lastname: de Waal
mesh_terms: D060666:Airway Extubation; D001775:Blood Circulation; D001794:Blood Pressure; D015331:Cohort Studies; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D011446:Prospective Studies; D012121:Respiration, Artificial; D013501:Surface-Active Agents / Q000627:therapeutic use
chemical_list: D013501:Surface-Active Agents
keywords: Cardiac output; Echocardiography; Hemodynamics; INSURE; Newborn; Surfactant