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Open Access 12-10-2023 | Non-Invasive Ventilation | RESEARCH

Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study

Authors: Isabelle Guellec, Thierry Debillon, Cyril Flamant, Pierre-Henri Jarreau, Benjamin Serraz, Pierre Tourneux

Published in: European Journal of Pediatrics | Issue 12/2023

Abstract

Management of respiratory distress (RD) in the extremely preterm newborn meets recommendations. Few data are available concerning the management and the clinical course of moderate and late preterms with RD. Clinical course and management among moderate (30–33 weeks (wks) of gestation) and late preterms (34–36 wks) were assessed in the Neobs study, a French neonatal observational cohort study (2018) of preterms with RD in the first 24 h of life. Clinical course was defined as stable (use of non-invasive ventilation (NIV) only), initially severe (initial use of invasive ventilation (IV)), and worsening (switch off IV after NIV support). Surfactant therapy instillation and withdrawal of all ventilator support at 72 h were recorded. Among moderate (n = 279) and late (n = 281) preterms, the clinical course was similar (p < 0.27): stable (82.1 and 86.8%), worsening (11.8% and 9.3%), and initially severe RD (6.1% and 3.9%), respectively. Surfactant was administered more frequently in the moderate versus late preterm groups (28.3% vs 16.7%; p < 0.001). The recommended surfactant dose (200 mg/kg) was administered in 53.3–83.3% of moderate and 42.1–63.2% of late preterms according to the clinical course. Withdrawal of ventilatory support at 72 h was observed in 40.0% and 70.0% of moderate and late preterms, respectively (p < 0.05), and was significantly (p < 0.001) associated with clinical course (the minus proportion among the worsening group).

Conclusion: While the proportion of clinical course pattern is similar in moderate and late preterm infants, the management of RD varies with gestational age, with late preterm infants being managed later in life and moderate premature infants weaned from ventilation at a later stage.

What is Known: • There is a lack of clear guidance on the management of respiratory distress (RD) in moderate-to-late preterm infants. • Neobs was a multicentre, observational study designed to characterise the real-world management of moderate-to-late preterm infants with RD in France.
What is New: • Secondary analyses of Neobs study data found that ventilatory support strategies were dependent on gestational age despite a similar clinical course. • At 30–33 weeks of gestation (wks), infants were more likely to receive non-invasive ventilation at delivery, while 34–36 wks infants were more likely to be managed using a wait-and-see approach.

Escobar GJ, Clark RH, Greene JD (2006) Short-term outcomes of infants born at 35 and 36 weeks gestation: need to ask more questions. Semin Perinatol 30(1):28–33. https://doi.org/10.1053/j.semperi.2006.01.005CrossRefPubMed

Consortium on Safe Labor, Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S et al (2010) Respiratory morbidity in late preterm births. JAMA 304(4):419–425. https://doi.org/10.1001/jama.2010.1015CrossRef

Reuter S, Moser C, Baack M (2014) Respiratory distress in the newborn. Pediatr Rev 35(10):417–428. https://doi.org/10.1542/pir.35-10-417CrossRefPubMedPubMedCentral

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A et al (2019) European consensus guidelines on the management of respiratory distress syndrome – 2019 update. Neonatology 115(4):432–450. https://doi.org/10.1159/000499361CrossRefPubMed

Debillon T, Tourneux P, Guellec I, Jarreau PH, Flamant C (2021) Respiratory distress management in moderate and late preterm infants: the NEOBS study. Arch Pediatr 28(5):392–397. https://doi.org/10.1016/j.arcped.2021.03.010CrossRefPubMed

Shah BA, Fabres JG, Leone TA, Schmölzer GM, Szyld EG, International Liaison Committee on Resuscitation Neonatal Life Support Task Force (2022) Continuous positive airway pressure for term and ≥34⁺⁰ weeks’ gestation newborns at birth: a systematic review. Resusc Plus 12:100320. https://doi.org/10.1016/j.resplu.2022.100320CrossRef

Osman AM, El-Farrash RA, Mohammed EH (2019) Early rescue Neopuff for infants with transient tachypnea of newborn: a randomized controlled trial. J Matern Fetal Neonatal Med 32(4):597–603. https://doi.org/10.1080/14767058.2017.1387531CrossRefPubMed

Celebi MY, Alan S, Kahvecioglu D, Cakir U, Yildiz D, Erdeve O et al (2016) Impact of prophylactic continuous positive airway pressure on transient tachypnea of the newborn and neonatal intensive care admission in newborns delivered by elective cesarean section. Am J Perinatol 33(1):99–106. https://doi.org/10.1055/s-0035-1560041CrossRefPubMed

Sur A, Paria A (2022) Weaning of invasive ventilation in the neonatal intensive care: towards standardising practice: a narrative review. J Paediatr Child Health 58(6):962–968. https://doi.org/10.1111/jpc.15995CrossRefPubMed

10.

Di Filippo P, Dodi G, Di Pillo S, Chiarelli F, Attanasi M (2022) Effect of invasive mechanical ventilation at birth on lung function later in childhood. Front Pediatr 10:912057. https://doi.org/10.3389/fped.2022.912057CrossRefPubMedPubMedCentral

11.

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R et al (2017) European consensus guidelines on the management of respiratory distress syndrome – 2016 update. Neonatology 111(2):107–125. https://doi.org/10.1159/000448985CrossRefPubMed

12.

Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Boyle E, Roehr CC (2022) Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 107(4):393–397. https://doi.org/10.1136/archdischild-2021-322890CrossRefPubMed

13.

Kruczek P, Krajewski P, Hożejowski R, Szczapa T (2021) FiO₂ before surfactant, but not time to surfactant, affects outcomes in infants with respiratory distress syndrome. Front Pediatr 9:734696. https://doi.org/10.3389/fped.2021.734696CrossRefPubMedPubMedCentral

14.

Jourdain G, Zacaria F, Ammar F, De Luca D (2016) Appropriateness of surfactant dosing for preterm babies with respiratory distress syndrome: retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 101(2):F182-183. https://doi.org/10.1136/archdischild-2015-310195CrossRefPubMed

15.

Boix H, Rite S, Arruza L, Fernandez C, Serrano I, Baquedano I et al (2019) Underdosing of surfactant for preterm babies with respiratory distress syndrome in clinical practice: a retrospective cohort study. Am J Perinatol 36(9):943–948. https://doi.org/10.1055/s-0038-1675645CrossRefPubMed

16.

Dani C, Ravasio R, Fioravanti L, Circelli M (2014) Analysis of the cost-effectiveness of surfactant treatment (Curosurf®) in respiratory distress syndrome therapy in preterm infants: early treatment compared to late treatment. Ital J Pediatr 40:40. https://doi.org/10.1186/1824-7288-40-40CrossRefPubMedPubMedCentral

17.

Bahadue FL, Soll R (2012) Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 11(11):CD001456. https://doi.org/10.1002/14651858.CD001456.pub2

18.

Cornette L, Mulder A, Debeer A, Malfilâtre G, Rigo V, Cools F et al (2021) Surfactant use in late preterm infants: a survey among Belgian neonatologists. Eur J Pediatr 180(3):885–892. https://doi.org/10.1007/s00431-020-03806-1CrossRefPubMed

19.

Sarafidis K, Chotas W, Agakidou E, Karagianni P, Drossou V (2021) The intertemporal role of respiratory support in improving neonatal outcomes: a narrative review. Children (Basel) 8(10):883. https://doi.org/10.3390/children8100883CrossRefPubMed

20.

Rodriguez-Fanjul J, Corsini I, Ortí CS, Bobillo-Perez S, Raimondi F (2022) Lung ultrasound to evaluate lung recruitment in neonates with respiratory distress (RELUS study). Pediatr Pulmonol 57(10):2502–2510. https://doi.org/10.1002/ppul.26066CrossRefPubMed

Title: Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study
Authors: Isabelle Guellec
Thierry Debillon
Cyril Flamant
Pierre-Henri Jarreau
Benjamin Serraz
Pierre Tourneux
Publication date: 12-10-2023
Publisher: Springer Berlin Heidelberg
Keyword: Non-Invasive Ventilation
Published in: European Journal of Pediatrics / Issue 12/2023
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-023-05259-8

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Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study

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