Guidelines for ventilator use help premature infants breathe easier
Guidelines that reduce the use of mechanical ventilation with premature infants in favor of a gentler form of respiratory support can profoundly affect those children's outcomes while reducing the cost of care, according to a team of researchers at Children's Hospital Boston.
The team, led by Bernadette Levesque, MD, of the Division of Newborn Medicine at Children's Hospital Boston and the Neonatal Intensive Care Unit (NICU) at St. Elizabeth's Medical Center in Boston, published their findings today online in Pediatrics. Children's operates the NICU at St. Elizabeth's as part of its efforts to promote community access to pediatric care.
Babies born prematurely are often placed promptly on a mechanical ventilator with a tube in the airway (intubation) and with supplemental oxygen to help their immature lungs breathe. The excess pressure placed on the infant's lungs can lead to ventilator-induced inflammation, scarring, and potentially bronchopulmonary dysplasia (BPD), a disabling chronic lung disease.
"While they are sometimes necessary, both supplemental oxygen and mechanical ventilation are essentially toxic to premature babies' lungs," said Levesque, who is also an instructor in pediatrics at Harvard Medical School. "These guidelines really represent five different interventions aimed at limiting those exposures."
The study centered on five care guidelines intended to encourage the use of a "bubble" continuous positive airway pressure (bCPAP) system, rather than mechanical ventilators, and limit exposure to supplemental oxygen. The bCPAP system delivers warmed, humidified oxygen in a way that inflates a premature infant's lungs more gently. The five guidelines exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of nasal cannula oxygen before 35 weeks of age were implemented in the St. Elizabeth's NICU by Children's staff in 2007.
"There is a long-standing but growing movement away from the use of mechanical ventilators with these children, and while there have been other large studies, they have only focused on provision of CPAP in the delivery room," Levesque noted. "That's not the whole story, and we think that by putting all five in place at the same time we are giving these children more complete support."
The researchers compared the outcomes of 60 infants born between seven and 16 weeks premature and admitted to the St. Elizabeth's NICU after the bCPAP guidelines were put in place with those of 61 similar infants admitted in the year before. Their analysis showed that those treated according to the new guidelines were less likely to be intubated or to need mechanical ventilation or surfactant (which can help keep a premature infant's lungs open), and needed fewer days on supplemental oxygen overall. They also saw downward trends in the numbers of children treated for BPD and low blood pressure (hypotension).
In addition, the team noted reductions in the equipment costs associated with care for the children treated under the new guidelines, as well as in medication costs related to surfactant treatment.
"We would love to see all premature babies receive the benefits of bCPAP-based care," Levesque concluded. "We are already seeing expanded interest in these guidelines at other area hospitals, and are working with some of the hospitals that refer premature babies to us to use bCPAP as early as possible, particularly in the delivery room."
Provided by Children's Hospital Boston
- New treatment could reduce chronic lung disease in premature babies Apr 29, 2008 | not rated yet | 0
- Findings suggest optimal oxygen dose for preterm infants Jun 02, 2010 | not rated yet | 0
- Umbilical cord gene expression signals premature babies' lung disease risk Oct 04, 2007 | not rated yet | 0
- Premature babies to benefit from breathing-support trial Dec 10, 2010 | not rated yet | 0
- Unified approach to premature infant care improves patient outcomes Dec 01, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Siemens has presented the world's first ultrasound system with wireless transducers. The system's transducers, which can be easily operated with one hand, transmit ultrasound images via radio waves to the ...
Other 25 seconds ago | not rated yet | 0
(AP)—A woman who lost both hands, her left leg and right foot after contracting a flesh-eating disease has been fitted with prosthetic hands.
Other May 18, 2013 | not rated yet | 0
(AP)—Medical marijuana use in Illinois is now in Gov. Pat Quinn's hands after the state Senate approved legislation.
Other May 17, 2013 | 5 / 5 (1) | 0
A Nigerian court on Friday sentenced two officials from a pharmaceutical company to seven years in prison over the sale of an adulterated teething drug which killed 84 babies in 2008.
Other May 17, 2013 | not rated yet | 0
(HealthDay)—Many Americans feel that keeping out-of-pocket health care costs is more important than staying with the same primary care physician.
Other May 17, 2013 | not rated yet | 0
When tumours metastasise, they can block lymphatic vessels, as researchers from ETH Zurich have discovered using a new method. The lymphatic fluid subsequently has to find a new path through the tissue. Such ...
41 minutes ago | not rated yet | 0 |
(Medical Xpress)—Flinders University researchers are breaking new ground in a decade-long journey to pinpoint the function of two closely related proteins.
31 minutes ago | not rated yet | 0 |
(Medical Xpress)—Scientists at King's College London have discovered that Vitamin D has the potential to significantly reduce the symptoms of asthma. The study, led by Professor Catherine Hawrylowicz from ...
20 minutes ago | not rated yet | 0 |
(Medical Xpress)—Patients with the most severe and dangerous form of chronic anorexia are more likely to make a significant improvement towards recovery and stay in therapy if traditional psychological treatments are re-focused ...
20 minutes ago | not rated yet | 0
Every 20 seconds, a limb is lost as a consequence of diabetic foot ulcer that does not heal. To date, medical solutions that can change this situation are very limited. In his doctoral thesis Yue Shen from the Industrial ...
40 minutes ago | not rated yet | 0
(Medical Xpress)—The feared Legionella pneumophila is responsible for legionellosis, an infectious disease that can lead to pneumonia. To infect humans, this pathogen has developed a complex method that allows it to camouflage ...
50 minutes ago | not rated yet | 0