5. Springboard for research
The vocal cords are predominantly closed in preterm infants< 30 weeks gestation during transition after birth; an observational study.
Heesters V, Dekker J, Panneflek TJ, et al. The vocal cords are predominantly closed in preterm infants <30 weeks gestation during transition after birth; an observational study. Resuscitation. 2024;194:110053.
Building upon the work of van Vonderen et al. (2014), which demonstrated the power of video review to uncover knowledge gaps in stabilization procedures, Heesters et al. (2023) addressed this gap using an observational study using ultrasonography to visualize vocal cords. This example showcases how video review is not only a tool for immediate practice improvement, but a valuable springboard for research that generates impactful, evidence-based changes in medical care.
The Problem: The respiratory drive in preterm infants is often insufficient to establish lung aeration at birth, which is necessary during transition from intra-uterine to extra-uterine life. Current non-invasive respiratory support methods are ineffective in achieving lung aeration unless the infants breathes spontaneously. It was speculated that active closure of the vocal cords causes obstruction and prevents air from entering the lungs.
The Breakthrough: Ultrasound unlocks the secrets of newborn airways.
What We Discovered:
Feasibility: Ultrasound effectively visualizes vocal cords in preterm infants without hindering standard care.
Closed for Business: vocal cords are often in closed position at birth, especially in apnea. We often observed expiratory braking manoeuvres (EBMs), which are characterized by adduction of the VCs during mid to late expiration that interrupts expiratory air flow. EBMs play an important role in defending end-expiratory lung gas volumes during and immediately after lung aeration and can be triggered by a declining functional residual capacity (FRC)
The Wasted Breath: Standard non-invasive ventilation (iPPV) is less effective with closed airways.
The Power of Timing: A baby's breaths open the door to better support.
Implications
Rethinking the Norm: This study challenges current iPPV practices, highlighting the need to promote spontaneous breathing.
The Future is Synchronized: Synchronizing iPPV with preterm infants' respiratory efforts could improve outcomes.
Precision Support: Visualizing VCs offers a potential tool for personalized respiratory support strategies during neonatal transition.
The Next Steps:
More Evidence Needed: on how to stimulate the infant to start breathing spontaneously.
Technology to the Rescue: Developing synchronized ventilation tools for preterm infants can be beneficial.
In conclusion, this study provides groundbreaking insights into preterm respiratory physiology at birth. These findings show how video review, leading to new research initiatives, revolutionizes how we support these vulnerable infants, leading to better, more targeted respiratory care.
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