Page 13 - Physiological based CPAP for preterm infants at birth Tessa Martherus

was doing. The father was encouraged to touch her and he was asked to gently rub the sole
of her feet. The increase in CPAP level, caffeine and tactile stimulation had a positive effect P and the respiratory effort increased and became more regular, yet the oxygen saturation remained around 85%. To improve the oxygen saturation, the nurse increased the supplemental oxygen concentration to 100%. The oxygen saturation rose and once it was
above 95%, they titrated down the inspired oxygen concentration. Eventually, the little baby
girl was spontaneously breathing on 8 cmH2O CPAP with an inspired oxygen content of 40%
before she was transferred to the Neonatal Intensive Care Unit. However, before being placed
in the transport incubator she was first given to her mother so she can meet and touch her daughter.
In recent years, the focus of respiratory support for extremely preterm infants in the delivery room has shifted from intubation and mechanical ventilation towards stimulating and supporting spontaneous breathing. Although it has been shown that applying CPAP is beneficial for supporting the breathing effort at birth, little research has investigated the optimal level of CPAP. In fact, the choice of CPAP level given to this baby was largely based on “eminence-based” medicine, where expert opinion dictates “this is how we do this”. There is no CPAP titration recommended and the current recommendation in how much CPAP (level) should be given is merely based on a mix of the current practice in the neonatal unit, expert opinion and extrapolations from preclinical studies in animals that have already transitioned. In recent years, it has become clear that the transition to newborn life at birth is a vulnerable moment for preterm infants with prompt changes in pulmonary characteristics. It is likely that the CPAP strategy required in the delivery room is completely different to the CPAP protocols used in the neonatal unit. This thesis therefore focusses on optimising CPAP used at birth to support spontaneous breathing of preterm infants.
Preface
9