Abstract
Background: Survival of infants requiring neonatal intensive care is improving, but infants may suffer complications related to stabilisation in the delivery suite and ongoing mechanical ventilation. Aim: To undertake a series of studies to optimise ventilatory support both when infants require stabilisation at delivery and also those invasively ventilated on the neonatal unit, with a particular focus on those with evolving or established bronchopulmonary dysplasia (BPD), and congenital diaphragmatic hernia (CDH).Methods: A series of studies were undertaken.
1.A randomised crossover study of the work of breathing (WOB), measured by the pressure-time product of the diaphragm (PTPdi), at different levels of volume targeting in prematurely-born infants with evolving or established BPD
2.A randomised crossover study of the WOB, measured by the PTPdi, at different levels of volume targeting in infants with CDH
3.A randomised crossover study of neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV) in prematurely-born infants with evolving or established BPD.
4.A randomised controlled trial of a fifteen second sustained inflation versus standard five ‘inflation breaths’ lasting two to three seconds during resuscitation at delivery of prematurely-born infants.
5.A study investigating whether the diaphragm EMG measured before extubation predicts those infants who would extubate successfully
6.A retrospective analysis of the time taken for carbon dioxide to be detected following intubation at delivery in prematurely-born infants
Results: Higher levels of volume targeting (7ml/kg) reduced the work of breathing compared to baseline ventilation and lower levels of volume targeting in infants with evolving/established BPD. In infants with CDH, 5ml/kg reduced the WOB compared to 4ml/kg. There was no significant difference in the oxygenation index between infants ventilated on NAVA and on PAV. A fifteen second sustained inflation during stabilisation at delivery provoked a spontaneous respiratory effort sooner and infants had a reduced duration of ventilation in the first 48 hours. The diaphragm EMG was a poor predictor of successful extubation. There was wide variation in the time taken for carbon dioxide to be detected following intubation.
| Date of Award | 1 Mar 2021 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Anne Greenough (Supervisor), Theodore Dassios (Supervisor) & Kamal Ali (Supervisor) |