How has research in the past 5 years changed my clinical practice
- Professor Anne Greenough, Deparment of Child Health, 4th Floor Golden Jubilee Wing, King’s College Hospital, London SE5 9RS, UK; anne.greenough{at}kcl.ac.uk
- Accepted 14 March 2007
Abstract
This article discusses how research in the past 5 years into management strategies influencing respiratory outcomes has changed (or not changed) the author’s clinical practice. Changes include using inhaled nitric oxide but no longer systemic pulmonary vasodilators in term born infants with pulmonary hypertension. Use of postnatal steroids is now restricted to systemic administration in infants with severe respiratory failure and who are ventilator dependent beyond 2 weeks of age. Infants with bronchopulmonary dysplasia, unless they have pulmonary hypertension, are maintained at oxygen saturation levels of 90–92% rather than ≥95%. Supine sleeping is instituted in prematurely born infants without contraindications several weeks prior to neonatal discharge to reinforce to parents the importance of supine sleeping their baby at home. Further research is required to identify the optimal respiratory support strategy, particularly for very immature infants.
Footnotes
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Funding: Research on the Newborn Unit at King’s College Hospital is supported by the WellChild Trust and Foundation for the Study of Sudden Infant Death.
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Competing interests: AG has held grants from various ventilator manufacturers; AG had received honoraria for giving lectures and advising various ventilator manufacturers.
- Abbreviations:
- A/C
- assist control
- BPD
- bronchopulmonary dysplasia
- CPAP
- continuous positive airway pressure
- ECMO
- extracorporeal membrane oxygenation
- HFOV
- high frequency oscillatory ventilation
- SIDS
- sudden infant death syndrome
- SIMV
- synchronous intermittent mandatory ventilation
- VCV
- volume cycled ventilation
- VTV
- volume targeted ventilation
