Non-invasive respiratory support in preterm infants.

Survival of preterm infants has increased steadily over recent decades, primarily due to improved outcomes for those born before 28 weeks of gestation. However, this has not been matched by similar improvements in longer-term morbidity. One of the key long-term sequelae of preterm birth remains bronchopulmonary dysplasia (also called chronic lung disease of prematurity), contributed primarily by the effect of early pulmonary inflammation superimposed on immature lungs. Non-invasive modes of respiratory support have been rapidly introduced providing modest success in reducing the incidence of bronchopulmonary dysplasia when compared with invasive mechanical ventilation, and improved clinical practice has been reported from population-based studies. We present a comprehensive review of the key modes of non-invasive respiratory support currently used in preterm infants, including their mechanisms of action and evidence of benefit from clinical trials.

Respiratory morbidity in children with cerebral palsy: an overview.

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

MORBILIDAD RESPIRATORIA EN NIÑOS CON PARÁLISIS CEREBRAL: UNA VISIÓN GENERAL: Los problemas respiratorios tienen un impacto significativo sobre la morbilidad y mortalidad en pacientes con parálisis cerebral (PC). En particular, aspiraciones recurrentes, incapacidad para despejar la vía aérea, deformidades de la columna y del tórax, deterioro de la función pulmonar, un pobre estado nutricional e infecciones pulmonares recurrentes, afectan negativamente el estado respiratorio. La displasia broncopulmonar puede contribuir a estos problemas pulmonares, pero el asma no es más común en PC que en la población general. Discutimos las opciones terapéuticas para cada uno de estos factores. La coexistencia e interacción de múltiples factores que influencian el estado respiratorio de las pacientes con PC deben ser reconocidos y tratados efectivamente para reducir la morbilidad respiratoria y la mortalidad.

MORBIDADE RESPIRATÓRIA EM CRIANÇAS COM PARALISIA CEREBRAL: UM PANORAMA: Problemas respiratórios têm impacto significativo na morbidade e mortalidade em pacientes com paralisia cerebral (PC). Em particular, aspiração recorrente, limpeza deficiente das vias aéreas, deformidade espinhal e torácica, função pulmonar deficiente, pobre estado nutricional, e infecções respiratórias recorrentes podem afetar o estado respiratório negativamente. A displasia broncopulmonar pode contribuir para problemas pulmonares, mas a asma não é mais comum em PC do que na população geral. Nós discutimos opções de tratamento para cada um destes fators. Múltiplos fatores coexistentes ou que interagem e que influenciam o estado respiratório de pacientes com PC devem ser reconhecidos e efetivamente abordados para reduzir a morbidade e mortalidade respiratória.