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Is it feasible to identify preterm infants with respiratory distress syndrome for early extubation to continuous positive airway pressure post‐surfactant treatment during retrieval?
Author(s) -
Priyadarshi Archana,
Quek Wei Shern,
Luig Melissa,
Lui Kei
Publication year - 2015
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.12724
Subject(s) - medicine , respiratory distress , mean airway pressure , continuous positive airway pressure , gestational age , anesthesia , mechanical ventilation , surfactant therapy , pediatrics , pregnancy , biology , obstructive sleep apnea , genetics
Aim Preterm infants with respiratory distress syndrome ( RDS ) requiring surfactant treatment are often retrieved mechanically ventilated to the receiving hospital. INSURE ( IN tubate, SUR factant, E xtubate) technique is not routinely performed by N ewborn and P ediatric E mergency T ransport S ervices NSW ( NETS ) during retrieval. This study aims to evaluate the likelihood of using INSURE technique during retrieval. We attempted to study the clinical characteristics of preterm infants with RDS who were favourably extubated ( FE ) shortly after admission to the receiving hospital. Methods Retrospective study of preterm infants, gestational age ( GA ) > 28 weeks with RDS requiring retrieval by NETS . Results Two hundred twenty‐three infants, median GA of 33 weeks (range 29–36), median birthweight 2200 g (1000–4080) were examined. A percentage of 49.7 received CPAP , and 50.3% required MV . Eighteen (16%) infants were FE (<6 h) at receiving hospital. FiO 2 on stabilisation ( FiO 2 (st)) by NETS correlated with FiO 2 on admission to receiving hospital ( r = 0.863). A percentage of 81 of ventilated infants received premedications including morphine. No significant differences were noted for GA , stabilisation ventilator settings, surfactant dose (mean 155 mg/kg) and mode of transport between FE and non‐ FE groups. FiO 2 (st) post‐surfactant treatment was significantly lower in FE compared with non‐ FE group (mean 0.28 vs. 0.41 respectively). The area under the curve from receiver operating characteristic based on FiO 2 (st) was 0.646 ( P = 0.050), the sensitivity and specificity of FiO 2 (st) cut‐off points (between 0.25 and 0.30) was low. Conclusion FiO 2 on stabilisation post‐surfactant treatment has a weak predictive value and may not be adequate to be used as sole criteria to extubate to CPAP prior to transport. FiO 2 at stabilisation should be included as an eligibility criteria for a randomised trial of INSURE during retrieval, but other clinical assessments are needed.