Non-Invasive Ventilation in Neonatology.

Continuous Positive Airway Pressure Humans Infant, Newborn Infant, Premature Intermittent Positive-Pressure Ventilation / methods Meta-Analysis as Topic Neonatology Noninvasive Ventilation / methods Randomized Controlled Trials as Topic Respiratory Distress Syndrome, Newborn / therapy Treatment Outcome

Journal

Deutsches Arzteblatt international
ISSN: 1866-0452
Titre abrégé: Dtsch Arztebl Int
Pays: Germany
ID NLM: 101475967

Informations de publication

Date de publication:
08 03 2019
Historique:
received: 29 05 2018
revised: 29 05 2018
accepted: 21 01 2019
entrez: 25 4 2019
pubmed: 25 4 2019
medline: 15 4 2020
Statut: ppublish

Résumé

Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes. We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes. Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]). Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.

Sections du résumé

BACKGROUND
Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes.
METHODS
We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes.
RESULTS
Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]).
CONCLUSION
Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.

Identifiants

DOI: 10.3238/arztebl.2019.0177 PMID: 31014448 PMC: PMC6503172
pubmed: 31014448
pii: arztebl.2019.0177
doi: 10.3238/arztebl.2019.0177
pmc: PMC6503172
doi:
pii:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

177-183

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Auteurs

Judith Behnke (J)

Department of General Pediatrics & Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen; Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin; Member of the German Lung Research Center (DZL), Giessen.

Brigitte Lemyre (B)

Christoph Czernik (C)

Klaus-Peter Zimmer (KP)

Harald Ehrhardt (H)

Markus Waitz (M)

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Ventilation en pression positive continue › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Prématuré › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Ventilation en pression positive intermittente › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méta-analyse comme sujet › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Professions de santé › Médecine › Pédiatrie › Néonatologie › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation non effractive › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies néonatales › Maladies du prématuré › Syndrome de détresse respiratoire du nouveau-né › Non-Invasive Ventilation in Neonatology.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Non-Invasive Ventilation in Neonatology.