Early Respiratory Management of Respiratory Distress Syndrome in Very Preterm Infants and Bronchopulmonary Dysplasia: A Case-Control Study

BACKGROUND: In the period immediately after birth, preterm infants are highly susceptible to lung injury. Early nasal continuous positive airway pressure (ENCPAP) is an attempt to avoid intubation and may minimize lung injury. In contrast, ENCPAP can fail, and at that time surfactant rescue can be less effective. OBJECTIVE: To compare the pulmonary clinical course and outcome of very preterm infants (gestational age 25–32 weeks) with respiratory distress syndrome (RDS) who started with ENCPAP and failed (ECF group), with a control group of infants matched for gestational age, who were directly intubated in the delivery room (DRI group). Primary outcome consisted of death during admission or bronchopulmonary dysplasia (BPD). RESULTS: 25 infants were included in the ECF group and 50 control infants matched for gestational age were included in the DRI group. Mean gestational age and birth weight in the ECF group were 29.7 weeks and 1,393 g and in the DRI group 29.1 weeks and 1,261 g (p = NS). The incidence of BPD was significantly lower in the ECF group than in the DRI group (4% vs. 35%; P<0.004; OR 12.6 (95% CI 1.6–101)). Neonatal mortality was similar in both groups (4%). The incidence of neonatal morbidities such as severe cerebral injury, patent ductus arteriosus, necrotizing enterocolitis and retinopathy of prematurity, was not significantly different between the two groups. CONCLUSION: A trial of ENCPAP at birth may reduce the incidence of BPD and does not seem to be detrimental in very preterm infants. Randomized controlled trials are needed to test whether early respiratory management of preterm infants with RDS plays an important role in the development of BPD

Mild asthma in overweight women: A new phenotype?

BACKGROUND: Epidemics of asthma and overweight have been linked recently. They might be associated with systemic inflammation. In asthma hyperresponsiveness to adenosine (AMP) is more closely related to inflammation than to methacholine (MCh). The aim of the study was to determine responsiveness to AMP and MCh in overweight compared with normal weight asthmatics. METHODS: Thirty women were enrolled (19 overweight) with mild controlled asthma according to GINA. A Body Mass Index (BMI) less than 25kg/m(2) was considered as normal and a BMI above 25kg/m(2) as overweight. We assessed the recent control of asthma (ACQ), pulmonary function tests, bronchial responsiveness to MCh and AMP (PC(20) and O'Connor two-point dose-response slope), perception of symptoms (Borg scale), and blood inflammatory markers (leptin and hs-CRP by ELISA). RESULTS: Overweight had a significant lower dose-response slope of the MCh challenge (p=0.009) as compared to normal weight patients, whereas no significant difference was observed for AMP challenge (p=0.27). Overweight patients had higher intercepts of the Borg scale measured before the MCh and AMP challenge tests (p=0.01 and p=0.03). Plasma leptin (p=0.001) and hs-CRP (p=0.05) concentrations were higher in overweight than normal weight patients. There was no correlation between challenges and inflammatory markers. CONCLUSIONS: Overweight asthmatic women have more pronounced systemic inflammation, but are less responsive to MCh. AMP responsiveness appeared to be comparable between both groups. Our findings suggest that overweight asthmatic women do not feature increased airway inflammation, but do represent a distinct phenotype as compared to normal weight patient

Pulmonary characteristics of neonates with RDS who failed ENCPAP treatment (ECF) and matched infants who were intubated in the DR (DRI).

<p>ENCPAP = early nasal continuous positive pressure; RDS = respiratory distress syndrome; HFOV = high frequency oscillation ventilation.</p

Figure 2

<p>Distribution of delivery room intubation, ENCPAP and ENCPAP-failure plotted against gestational age. DRI = delivery room intubation; ENCPAP = early continuous positive airway pressure.</p

Comparison of characteristics of infants with RDS who failed treatment with ENCPAP (ECF) and matched infants who were intubated immediately after birth in the delivery room (DRI).

<p>BW = birth weight; ENCPAP = early nasal continuous positive pressure; GA = gestational age; PPROM = preterm premature rupture of the membranes; IUGR = intra- uterine growth retardation.</p

Figure 1

<p>The distribution of need of ventilatory support in very preterm neonates (25–33 weeks of gestation). ENCPAP = early nasal continuous positive airway pressure; mask and bag: using a self-inflating bag.</p

Primary outcome of infants who failed ENCPAP treatment (ECF) and matched infants who were intubated in the delivery room (DRI).BPD_mod-sev = moderate and severe bronchopulmonary dysplasia.

<p>Primary outcome of infants who failed ENCPAP treatment (ECF) and matched infants who were intubated in the delivery room (DRI).BPD_mod-sev = moderate and severe bronchopulmonary dysplasia.</p