Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Recruitment and Data Collection
2.2. Noninvasive Ventilation
2.3. Silverman-Andersen Score
2.4. Weaning Process
2.5. Outcome Parameters
2.6. Interrater Reliability Testing
2.7. Statistics
3. Results
3.1. Patients
3.2. Analysis of the Weaning Process
3.3. Effect of Routine SAS Assessment on NIV Outcome Parameters
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Behnke, J.; Lemyre, B.; Czernik, C.; Zimmer, K.P.; Ehrhardt, H.; Waitz, M. Non-Invasive Ventilation in Neonatology. Dtsch. Arztebl. Int. 2019, 116, 177–183. [Google Scholar] [CrossRef] [PubMed]
- Finer, N.N.; Carlo, W.A.; Walsh, M.C.; Rich, W.; Gantz, M.G.; Laptook, A.R.; Yoder, B.A.; Faix, R.G.; Das, A.; Poole, W.K.; et al. Early CPAP versus surfactant in extremely preterm infants. N. Engl. J. Med. 2010, 362, 1970–1979. [Google Scholar] [CrossRef] [PubMed]
- Morley, C.J.; Davis, P.G.; Doyle, L.W.; Brion, L.P.; Hascoet, J.M.; Carlin, J.B. Nasal CPAP or intubation at birth for very preterm infants. N. Engl. J. Med. 2008, 358, 700–708. [Google Scholar] [CrossRef] [PubMed]
- Papile, L.A.; Baley, J.E.; Benitz, W.; Cummings, J.; Eichenwald, E.; Kumar, P.; Tan, R.C.; Wang, K.S.; Committee on Fetus and Newborn. Respiratory support in preterm infants at birth. Pediatrics 2014, 133, 171–174. [Google Scholar] [CrossRef]
- Sweet, D.G.; Carnielli, V.; Greisen, G.; Hallman, M.; Ozek, E.; Te Pas, A.; Plavka, R.; Roehr, C.C.; Saugstad, O.D.; Simeoni, U.; et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome—2019 Update. Neonatology 2019, 115, 432–450. [Google Scholar] [CrossRef]
- Hatch, L.D., 3rd; Clark, R.H.; Carlo, W.A.; Stark, A.R.; Ely, E.W.; Patrick, S.W. Changes in Use of Respiratory Support for Preterm Infants in the US, 2008-2018. JAMA Pediatr. 2021, 175, 1017–1024. [Google Scholar] [CrossRef]
- Doyle, L.W.; Carse, E.; Adams, A.M.; Ranganathan, S.; Opie, G.; Cheong, J.L.Y. Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years. N. Engl. J. Med. 2017, 377, 329–337. [Google Scholar] [CrossRef]
- Yong, S.C.; Chen, S.J.; Boo, N.Y. Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: A randomised control study. Arch. Dis. Childhood. Fetal Neonatal Ed. 2005, 90, F480–F483. [Google Scholar] [CrossRef]
- Jardine, L.; Davies, M.W. Withdrawal of neonatal continuous positive airway pressure: Current practice in Australia. Pediatr. Int. 2008, 50, 572–575. [Google Scholar] [CrossRef]
- Silverman, W.A.; Andersen, D.H. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 1956, 17, 1–10. [Google Scholar]
- Kribs, A.; Roll, C.; Göpel, W.; Wieg, C.; Groneck, P.; Laux, R.; Teig, N.; Hoehn, T.; Böhm, W.; Welzing, L.; et al. Nonintubated Surfactant Application vs. Conventional Therapy in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2015, 169, 723–730. [Google Scholar] [CrossRef]
- Rego, M.A.; Martinez, F.E. Comparison of two nasal prongs for application of continuous positive airway pressure in neonates. Pediatr. Crit. Care Med. 2002, 3, 239–243. [Google Scholar] [CrossRef] [PubMed]
- Hedstrom, A.B.; Gove, N.E.; Mayock, D.E.; Batra, M. Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO(2) and respiratory support in newborns: A prospective cohort study. J. Perinatol. Off. J. Calif. Perinat. Assoc. 2018, 38, 505–511. [Google Scholar] [CrossRef]
- Wilkinson, D.J.; Andersen, C.C.; Smith, K.; Holberton, J. Pharyngeal pressure with high-flow nasal cannulae in premature infants. J. Perinatol. Off. J. Calif. Perinat. Assoc. 2008, 28, 42–47. [Google Scholar] [CrossRef] [PubMed]
- Amatya, S.; Rastogi, D.; Bhutada, A.; Rastogi, S. Weaning of nasal CPAP in preterm infants: Who, when and how? a systematic review of the literature. World J. Pediatr. 2015, 11, 7–13. [Google Scholar] [CrossRef] [PubMed]
- Tang, J.; Reid, S.; Lutz, T.; Malcolm, G.; Oliver, S.; Osborn, D.A. Randomised controlled trial of weaning strategies for preterm infants on nasal continuous positive airway pressure. BMC Pediatr. 2015, 15, 147. [Google Scholar] [CrossRef]
- Rastogi, S.; Wong, W.; Gupta, A.; Bhutada, A.; Maimonides Neonatal, G. Gradual versus sudden weaning from nasal CPAP in preterm infants: A pilot randomized controlled trial. Respir. Care 2013, 58, 511–516. [Google Scholar] [CrossRef]
- Todd, D.A.; Wright, A.; Broom, M.; Chauhan, M.; Meskell, S.; Cameron, C.; Perdomi, A.M.; Rochefort, M.; Jardine, L.; Stewart, A.; et al. Methods of weaning preterm babies. Arch. Dis. Childhood. Fetal Neonatal Ed. 2012, 97, F236–F240. [Google Scholar] [CrossRef]
- Miller, M.J.; Carlo, W.A.; Martin, R.J. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants. J. Pediatr. 1985, 106, 91–94. [Google Scholar] [CrossRef]
- Poets, C.F.; Roberts, R.S.; Schmidt, B.; Whyte, R.K.; Asztalos, E.V.; Bader, D.; Bairam, A.; Moddemann, D.; Peliowski, A.; Rabi, Y.; et al. Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants. JAMA 2015, 314, 595–603. [Google Scholar] [CrossRef]
- Poets, C.F. Interventions for apnoea of prematurity: A personal view. Acta Paediatr. 2010, 99, 172–177. [Google Scholar] [CrossRef] [PubMed]
- Hedstrom, A.B.; Faino, A.V.; Batra, M. The Silverman Andersen respiratory severity score in the delivery room predicts subsequent intubation in very preterm neonates. Acta Paediatr. 2020, 110, 1450–1451. [Google Scholar] [CrossRef] [PubMed]
- Shetty, S.; Sundaresan, A.; Hunt, K.; Desai, P.; Greenough, A. Changes in the use of humidified high flow nasal cannula oxygen. Arch. Dis. Childhood. Fetal Neonatal Ed. 2016, 101, F371–F372. [Google Scholar] [CrossRef] [PubMed]
- Heath Jeffery, R.C.; Broom, M.; Shadbolt, B.; Todd, D.A. Increased use of heated humidified high flow nasal cannula is associated with longer oxygen requirements. J. Paediatr. Child Health 2017, 53, 1215–1219. [Google Scholar] [CrossRef]
- Hoffman, S.B.; Terrell, N.; Driscoll, C.H.; Davis, N.L. Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay. Respir. Care 2016, 61, 1299–1304. [Google Scholar] [CrossRef]
- Taha, D.K.; Kornhauser, M.; Greenspan, J.S.; Dysart, K.C.; Aghai, Z.H. High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants. J. Pediatr. 2016, 173, 50–55. [Google Scholar] [CrossRef]
- Bamat, N.; Jensen, E.A.; Kirpalani, H. Duration of continuous positive airway pressure in premature infants. Semin. Fetal Neonatal Med. 2016, 21, 189–195. [Google Scholar] [CrossRef]
- Gizzi, C.; Massenzi, L.; Pattumelli, M.G.; Moretti, C.; Agostino, R. Weaning of infants from non invasive ventilation. Acta Bio-Med. Atenei Parm. 2014, 85, 15–19. [Google Scholar]
- Rastogi, S.; Rajasekhar, H.; Gupta, A.; Bhutada, A.; Rastogi, D.; Wung, J.T. Factors Affecting the Weaning from Nasal CPAP in Preterm Neonates. Int. J. Pediatr. 2012, 2012, 416073. [Google Scholar] [CrossRef] [Green Version]
SAS Group (n = 33) | Control Group (n = 33) | p-Value | |
---|---|---|---|
Gestational age (weeks) | 29.0 (2.2) | 29.1 (2.2) | 0.90 |
Birth weight (g) | 1267 (314) | 1282 (280) | 0.84 |
Female gender (n) | 11 (33%) | 11 (33%) | >0.99 |
Cesarean section (n) | 28 (85%) | 24 (73%) | 0.37 |
Antenatal corticosteroids (n) | 0.80 | ||
Complete cycle # | 21 (64%) | 23 (70%) | |
Incomplete cycle | 6 (18%) | 8 (24%) | |
None | 6 (18%) | 2 (6%) | |
APGAR | |||
5 min | 8.2 (1.9) | 8.3 (2.1) | 0.90 |
10 min | 9.3 (0.9) | 9.2 (1.3) | 0.74 |
Surfactant * (n) | 26 (79%) | 22 (67%) | 0.41 |
Intubation * (n) | 5 (15%) | 3 (9%) | 0.71 |
Caffeine treatment * (n) | 30 (91%) | 29 (88%) | >0.99 |
Mode of ventilatory support (n) | |||
sNIPPV | 30 (91%) | 27 (82%) | 0.47 |
CPAP | 25 (76%) | 24 (73%) | >0.99 |
HHHFNC | 23 (70%) | 26 (79%) | 0.57 |
HHHFNC with PEEP < 3 cmH2O | 15 (45%) | 20 (61%) | 0.32 |
NAVA | 6 (18%) | 6 (18%) | n.a. |
Number of Days | SAS Group | Control Group | p-Value |
---|---|---|---|
Total NIV | 25 (3–55) | 27 (2–69) | 0.73 |
NIV ≥ 30 + 0 weeks CGA | 17 (3–45) | 20 (2–60) | 0.72 |
(s)NIPPV | 5.5 (1–39) | 5 (1–47) | 0.63 |
CPAP | 4 (1–16) | 4 (1–15) | 0.80 |
HHHFNC | 12 (3–26) | 15.5 (2–35) | 0.31 |
PEEP > 3 cmH2O | 10 (3–21) | 10.5 (2–22) | 0.98 |
PEEP ≤ 3 cmH2O | 2 (1–13) | 5 (1–17) | 0.10 |
Supplemental oxygen | 2 (1–62) | 3 (1–91) | 0.64 |
Length of hospital stay | 48 (24–101) | 47 (18–106) | 0.74 |
SAS Group | Control Group | p-Value | |
---|---|---|---|
Pneumothorax | 5 (15.2%) | 3 (9.1%) | 0.71 |
BPD | 5 (15.2%) | 5 (15.2%) | >0.99 |
PHT | 2 (6.1%) | 0 | 0.49 |
IVH ≥ 3° | 1 (3%) | 5 (15.2%) | 0.19 |
Hydrocephalus | 0 | 5 (15.2%) | 0.053 |
PVL | 1 (3%) | 0 | >0.99 |
PDA | 12 (36.4%) | 6 (18.2%) | 0.17 |
Sepsis | 11 (33.3%) | 12 (36.4%) | >0.99 |
NEC | 1 (3%) | 0 | >0.99 |
ROP * | 3 (9.1%) | 7 (21.2%) | 0.30 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nussbaum, C.; Lengauer, M.; Puchwein-Schwepcke, A.F.; Weiss, V.B.N.; Spielberger, B.; Genzel-Boroviczény, O. Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score. Children 2022, 9, 1292. https://doi.org/10.3390/children9091292
Nussbaum C, Lengauer M, Puchwein-Schwepcke AF, Weiss VBN, Spielberger B, Genzel-Boroviczény O. Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score. Children. 2022; 9(9):1292. https://doi.org/10.3390/children9091292
Chicago/Turabian StyleNussbaum, Claudia, Maximilian Lengauer, Alexandra F. Puchwein-Schwepcke, Veronique B. N. Weiss, Benedikt Spielberger, and Orsolya Genzel-Boroviczény. 2022. "Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score" Children 9, no. 9: 1292. https://doi.org/10.3390/children9091292