N ZAYAT

Hello Justinas, thank you for your very interesting answer. When I say that the initial management was ok, I mean that whatever the ventilation mode (biPAP of invasive ventilation), the parameters were quite standard with no oxygenation difficulties. Most of the 23/24 GA newborns in our NICU were on mechanical ventilation either since the delivery room, or a few hours later. Surfactant instillation was made using LISA or in the tube. We currently use prophylactic hydrocortisone for all infants born before 28 weeks GA. What happened for our last patients is a secondary intubation, often during an infection with increasing ventilation needs, firts in volume targeted mode, then in HFO with very high mean pressures (such as 18 to 20 cmH20, more than we ever used). Despite the iduced chest overdistension, we didn't manage to decrease the pressure regimen. My questions were: should we use NAVA right away? how to avoid high mean airway pressures and overdistension in HFO. Do you happen to use NO for these patients even without clear pulmonary hypertension in the US? Do you do catheter early ductus arteriosus closure (<15days) if large and if the medical treatment didn't work?

We recently welcomed many extreme preterms (23 24 GA) with particularly complicated respiratory insufficiency. The initial management was ok but secondary degradation often led to intubation and finaly aggressive ventilation with HFO due to high oxygen dependancy. we're used to use NAVA or volume ventilation but these different modes didn't work for our last patients. In the end steroids were attempted but not always successful. Do you have a specific respiratory management in these gestational ages in case of secondary intubation in terms of ventilation mode, general prescriptions...? Thank you for your help,