Ventilator Use Guidelines Help Premature Infants Breathe Easier

New Guidelines that reduce the use of mechanical ventilation in premature infants by preferring a gentler form of respiratory support can profoundly affect outcomes, according to a new study.

Researchers at Children's Hospital Boston (CHB; MA, USA) and St. Elizabeth's Medical Center (Boston, MA, USA) compared the outcomes of 60 infants born between 7 and 16 weeks premature during 2007, and admitted to the St. Elizabeth's neonatal intensive care unit (NICU) after "bubble" continuous positive airway pressure (bCPAP) guidelines were put in place, with those of 61 similar infants admitted in the year before.

The bCPAP system delivers warmed, humidified oxygen in a way that inflates a premature infant's lungs more gently. The five guidelines used included exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged continuous positive airway pressure (CPAP) with avoidance of nasal cannula oxygen before 35 weeks of age.

The results showed that those infants 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 bronchopulmonary dysplasia (BPD) and low blood pressure. In addition, the researchers 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. The study was published early online on January 18, 2011, in Pediatrics.

"We would love to see all premature babies receive the benefits of bCPAP-based care," said lead author Bernadette Levesque, MD, of the CHB division of newborn medicine. "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."

Premature babies are often promptly intubated and put on a mechanical ventilator to receive supplemental oxygen to help their immature lungs breathe. The excess pressure placed on the infant's lungs can sometimes lead to ventilator-induced inflammation, scarring, and potentially BPD, a disabling chronic lung disease.

Related Links:
Children's Hospital Boston
St. Elizabeth's Medical Center