Page 151 - Physiological based CPAP for preterm infants at birth Tessa Martherus
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extreme prematurity and the high vulnerability of these infants, interventions that stimulate and support spontaneous breathing could be packaged together and studied as a bundle of care. This will reduce the number of patients needed to test the effects (54).
Conclusion
Since the focus of respiratory support at birth has shifted to stimulating and supporting spontaneous breathing, CPAP support at birth should be reconsidered and adjusted to meet the physiological changes at birth. Preterm lamb and rabbit studies demonstrated that an initial 15 cmH2O CPAP improves lung aeration and provides cardiovascular stability. Once lung aeration has been established, CPAP levels should be decreased. We showed that the timing of the CPAP decrease is essential, but that at least 8 cmH2O is needed to maintain breathing rate and lung aeration in very immature newborns. In these preclinical studies, we found no indications that PB-CPAP increases the risk of adverse events e.g. pneumothoraxes. When PB-CPAP was introduced in the delivery room, it increased heart rate and shortened the duration of mask ventilation, which is consistent with the proposition that PB-CPAP lead to a better lung aeration. Despite the potential benefits, we found that our current PB-CPAP strategy is considered to be too complex for caregivers and requires simplification. Future studies may i) further explore potential benefits and adverse events of PB-CPAP and ii) explore how to simplify the decrease in CPAP levels while still being effective in maintaining aeration and oxygenation.
GD
General discussion
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