Respiratory Disorders

I apologise if this topic has already been covered. We’re currently discussing severe BPD cases, particularly infants who remain in the NICU beyond a corrected age of 44+0 weeks, with some even nearing six months. These prolonged stays bring unique challenges, such as the need for specialised training, appropriate equipment, and specific emergency protocols. For example, if a baby at a corrected age of four months experiences a collapse, should the team initiate resuscitation using an NLS/NRP approach, or should an APLS code be applied? In my experience, only one unit had a clear policy to guide these situations. I’d be very interested to hear how your units h…

Hi all, Has anyone cared for a patient with multiple unilateral missing ribs? I have a patient missing multiple ribs on the right side. Very low vent settings but failed extubation due to work of breathing. If you have experience with this has any surgical team tried a temporary rib cage intervention (metal insert) in attempt to avoid a tracheostomy? Or have you pursued tracheostomy to defer intervention for later in life? CXR

Hi All, Infant Flow/Inspire/First Breath/LP nCPAP generators are limited to XL masks and XL prongs and headgear. What do units do when a baby outgrows the largest sizes? This is a question I'm being asked more and more, despite it not being a new problem. Any suggestions of work arounds or equipment greatly received. Regards Owen

Are you using a steroid course in infants who are 36+ weeks CGA with BPD, who are not weaning on non-invasive ventilation? The group I am considering is 36-40 weeks CGA, who remain on CPAP with some oxygen requirement (~30%) and work of breathing/tachypnea who are not progressing. If so, which steroid (Decadron, Hydrocortisone, Prednisone, etc) and do you have a regimen? Thank you!

Preterm, severe RDS, ventilated, tension pneumothorax resolved with chest drain, no reaccumulation for >24 hours, low MAP, FiO2 25%, off iNO. Which you would do first - extubate or remove chest drain?

How do you approach weaning respiratory support in established BPD? I am caring for a former 23 week infant now 47 wk CGA. On Fisher Paykel CPAP +12, 21% FiO2, serum bicarbonate 26. No pulmonary hypertension on echo. On Pulmicort and Atrovent. Not having desaturation events. Hx NEC s/p 3 bowel resections, ROP, G4 bilateral IVH with PHH. S/p DART steroids x2. How do you wean from here? We have some team members who are reluctant to wean respiratory support because linear growth is suboptimal, but I feel that is likely due to multiple GI surgeries and periods of NPO and fluid shifts post-op. while not ideal, it doesn't seem like a reason NOT to wean the respiratory support …

This paper came on my LinkedIn radar, a paper showing that LISA was quite effective in meconium aspiration management, reducing the need for invasive ventilation and also NO need. Do you use LISA for this indication? BMJ Paediatrics OpenLess invasive surfactant administration for meconium aspi...Background The role of less invasive surfactant administration (LISA) using a thin catheter in the management of meconium aspiration syndrome (MAS) is unclear.Study design A retrospective study of...

Hi everybody, I would like to ask about the I:E ratio in an HFO-VG setting in case of ELGANs. Do you use an I:E ratio of 1:1 or 1:2 in HFO-VG on the VN800 for ELGANs 22-23 wks below 500g BW? Also would you worry of causing atelectasis using an I:E ratio of 1:2 when the infant is on low MAPs like 8 or 9 cmH2O, Frequency of 12Hz at DOL10 ?

Hello everyone, I am a third-year medical student from Brazil and we recently discussed an insightful retrospective study published in the Journal of Perinatology titled Don't Wait, Vaccinate. It compared the incidence of cardiorespiratory events in preterm infants receiving all routine 2-month vaccines on a single day versus on multiple days. The study found no significant difference in events like prolonged apnea or bradycardia between the groups. Single-day administration, however, reduced schedule interruptions, improving adherence to vaccination timelines. I'd like to hear your thoughts: Have you observed differences in outcomes with single-day…

This came on my radar, a systematic review about BPD rates. Nothing really new, but a good baseline paper to reference. https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02850-x