Sustained Lung Inflation EBNEO Review on sustained lung inflation and BPD incidence
BPD Very few proven strategies exist to prevent BPD development in VLBW neonates . This randomized controlled trial assessed the usefulness of combined intratracheal budesonide and surfactant administration in VLBWs with severe RDS in preventing BPD or death. The study revealed that treatment significantly reduced incidence of BPD or death; further study is necessary to assess cognitive outcomes in infants receiving combined budesonide and surfactant therapy.
HYDROCORTISONE Postnatal steroids represent an attractive therapeutic option for BPD prevention in extremely preterm neonates, but questions remain about their safety. This randomized controlled trial assessed the safety and efficacy of intravenous low-dose hydrocortisone administration to prevent BPD in ELBW neonates at 24-27 weeks’ gestational age. The trial revealed that survival without BPD was significantly improved in neonates receiving hydrocortisone. While further study is required to determine its long-term neurodevelopmental effects, the trial suggests that hydrocortisone may be effective in preventing BPD in ELBW infants.
CONFERENCE VIDEO SERIES: BARBARA SCHMIDT Watch as Barbara Schmidt discusses the strengths, weaknesses, and results of recent oxygen saturation trials in extremely preterm infants.
BPD Bronchopulmonary Dysplasia is a significant morbidity of prematurity for which few preventative therapies exist. This randomized controlled trial assessed the prophylactic effectiveness of inhaled budesonide vs. placebo in the prevention of BPD in high risk infants. The trial found no significant difference in the outcomes of death or BPD in infants who received inhaled budesonide. Although not statistically significant, mortality rate was higher in the budesonide group. Thus, inhaled budesonide cannot be recommended as a prophylactic for BPD.
Bronchopulmonary Dysplasia Permissive hypercapnia has been proposed as a way to limit ventilator-induced lung injury and prevent the development of BPD in preterm neonates. This randomized controlled trial assessed whether targeting higher PaCO2 in the first 14 days of life would prevent BPD in ELBW infants. Interim analysis revealed no benefit to permissive hypercapnia, and this study was stopped early (~20% of planned recruitment). Further study is needed to define the role of permissive hypercapnia in the NICU.
CAFFEINE Caffeine is a common therapy for apnea of prematurity; however, its long-term outcomes as a prophylactic treatment are unknown. This observational study assessed outcomes of early or late caffeine administration in premature neonates and found that early caffeine administration (<3 days of life) is associated with improved outcomes. These findings should be further studied in a randomized controlled trial before caffeine can be recommended as a prophylactic therapy.