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Review
. 2017 Nov;37(11):1171-1179.
doi: 10.1038/jp.2017.74. Epub 2017 Jun 1.

Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants

E E Foglia  1   2 , E A Jensen  1   2 , H Kirpalani  1   2
Affiliations
Review

Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants

E E Foglia et al. J Perinatol. 2017 Nov.

Abstract

Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (delivery room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the delivery room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (<2 h of life). We recommend prudent titration of supplemental oxygen in the delivery room to achieve targeted oxygen saturations. Promising interventions that may further reduce BPD, such as sustained inflation and non-invasive surfactant administration, are currently under investigation.

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Conflict of interest statement

Conflicts of Interest: Drs. Foglia and Kirpalani are investigators on the ongoing Sustained Aeration of Infant Lungs (SAIL) trial (clinicaltrials.gov Identifier NCT NCT02139800), which is referenced in this article. The authors have no other conflicts of interest to disclose

Figures

Figure 1
Figure 1
Forrest plot for the outcome of BPD among survivors, comparing less invasive surfactant administration (LISA) versus control therapy in extremely preterm infants.
Figure 2
Figure 2
Forrest plot for the outcome of death or BPD, comparing less invasive surfactant administration (LISA) versus control therapy in extremely preterm infants.
See this image and copyright information in PMC

References

    1. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA. 2015;314:1039–51. - PMC - PubMed
    1. Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics. 2012;129:1019–26. - PubMed
    1. Laughon MM, Langer JC, Bose CL, Smith PB, Ambalavanan N, Kennedy KA, et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med. 2011;183:1715–22. - PMC - PubMed
    1. Klinger G, Sokolover N, Boyko V, Sirota L, Lerner-Geva L, Reichman B, et al. Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol. 2013;208:115, e1–9. - PubMed
    1. Doyle LW, Faber B, Callanan C, Freezer N, Ford GW, Davis NM. Bronchopulmonary dysplasia in very low birth weight subjects and lung function in late adolescence. Pediatrics. 2006;118:108–13. - PubMed

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