Influence of Ventilation Modes on Cerebral Blood Flow Measurements of Intra- and Extracranial Arteries in Preterm Infants with Respiratory Distress Syndrome

Abstract

Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, is a common problem in preterm infants. This disorder is caused primarily by deficiency of pulmonary surfactant in an immature lung. RDS is a major cause of morbidity and mortality in preterm infants (Saker &Martin, 2014). The introduction of modern mechanical ventilation in neonatal medicine in the 1960s was followed shortly by its use in premature infants with hyaline membrane disease (John and Carlo, 2003). Progress in neonatal medicine has resulted in decrease of neonatal mortality, particularly in preterm infants. However, there are concerns about the adverse neurodevelopmental outcome of the survivors (Fawke, 2007). This work was designed to evaluate the influence of different modes of ventilation (either non-invasive or invasive) on cerebral blood flow measurements of the intra- and extra-cranial arteries, using Doppler Ultrasonography, in preterm infants ventilated for neonatal respiratory distress syndrome. This Case-Control study was conducted from January 2013 till January 2015 in the neonatal intensive care unit (NICU) of the Maternity Hospital of Ain Shams University, Cairo, Egypt. The study was conducted on total 80 preterm neonates.60 preterm neonates were included of gestational age ranging from 28-36 weeks with respiratory distress syndrome evident clinically and radiologically required respiratory support according to Down's score , Preterms with major congenital anomalies, intrauterine growth restriction (IUGR),hypoxic-ischemic encephalopathy (HIE), intraventricular hemorrhage (IVH) grade 3 or 4, major cardiac anomalies, Carotid occlusion were excluded.60 preterm neonates with respiratory distress syndrome requiring respiratory support were included. The other 20 preterm neonates were in stable general condition, with no respiratory distress, not requiring respiratory support, of matched gestational, postnatal age and sex was included as a control group.