Laryngeal closure impedes non-invasive ventilation at birth.

Autor:	Crawshaw JR; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Kitchen MJ; School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia., Binder-Heschl C; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia.; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria., Thio M; Newborn Research Centre, The Royal Women's Hospital, Melbourne, Vic, Australia., Wallace MJ; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Kerr LT; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia., Roehr CC; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia., Lee KL; School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia., Buckley GA; School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia., Davis PG; Newborn Research Centre, The Royal Women's Hospital, Melbourne, Vic, Australia.; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.; The Murdoch Children's Research Institute, Melbourne, Australia., Flemmer A; Division of Neonatology, University Children's Hospital and Perinatal Center, Ludwig Maximilian University, Munich, Germany., Te Pas AB; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands., Hooper SB; The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Clayton, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2018 Mar; Vol. 103 (2), pp. F112-F119. Date of Electronic Publication: 2017 Oct 20.
DOI:	10.1136/archdischild-2017-312681
Abstrakt:	Background: Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. Methods: We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Hypothesis: Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. Results: The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Conclusion: Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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