Research that could change the way premature babies breathe

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Many preterm infants need various treatments that support body systems that have not yet developed, or have not developed properly, before their premature birth. One of the common treatments for preterm infants is the need for respiratory assistance. The question is whether to perform an invasive or non-invasive soul?

Dr. Uri was born prematurely. Photo of Rambam’s spokeswoman

Has the controversy that has existed for years in the world of preterm medicine come to an end? A new and groundbreaking Israeli study reveals data, which make it possible, for the first time, to get answers that may change the way preterm infants are treated around the world.

Breathing in preterm infants can be done by invasive respiration with insertion of a tube into the trachea – in cases of severe distress of the preterm infant, or by non-invasive respiration, which uses a machine that keeps the lungs open and flows oxygen through tubes inserted into the tiny nose of the preterm. However, even the method that is considered less aggressive – the one with the tubes inserted into the nose, is not without problems – the hard tubes can cause damage, and rarely even significant damage, to the nose of the preterm infant. In recent years, a technique has been introduced that uses a thinner and finer tube that reduces the damage to the preterm nose, but two camps have been created – those that prefer the hard tubes, which are thought to provide better support, and are popular today in most preterm infants, and those who prefer thin and delicate tubes.

Now, the first clinical study of its kind conducted by Israeli researchers, presents new data, and proves that preterm infants can be feminized effectively and without damaging their delicate face. The study was recently published in the prestigious scientific journal JAMA Pediatrics and allows for a significant change in the daily care of many infants who need respiratory support.

The aggressive method can cause injury to the newborn

“The prevailing opinion among physicians is that the use of thick and rigid tubes allows for better transfer of soul pressure and support to preterm infants, compared to the use of thin tubes,” explains Dr. Uri Hochwald, a senior Rambam preterm doctor who is leading the study. Models Various that led to these conclusions, but no one has ever examined the issue on Patients. “In some cases the preterm infants who breathed more aggressively were injured by the tubes in their noses, sometimes significant injuries that would have taken time to heal, but the idea was to avoid invasive breathing that involved greater risks, so these injuries were in some cases less severe.”

The study, led by Rambam researchers (Dr. Hochwald and Prof. Amir Kugelman), was conducted in collaboration with the Bnei Zion Medical Center in Haifa (led by Prof. Arik Riskin) and surveyed 166 preterm infants who needed non-invasive respiration. The preterm infants were randomly divided into two groups, each receiving non-invasive resuscitation treatment using one of the methods used, with the aim of the study being the ability to avoid having to switch to invasive resuscitation for at least 72 hours in order to declare treatment successful and effective.

“This is a noninferiority study,” notes Dr. Hochwald. “The intention is that we do not test which of the methods is better, but prove that one is no less good than the other,” he adds, “in other words we wanted to prove that the new, gentler method is no less effective than the prevailing method.”

From the processing of the preterm infants’ data, it emerged that in the respiratory group using the thick tubes, which is commonly used in preterm infants around the world, the success rates of the treatment according to the established criteria were 82%. The second group, the one used in the thin tubes (the new method), showed a success rate of 86%, according to the same criteria, and with a significantly lower percentage of injury in the patients’ noses.

“The results of the study mean that we have been able to prove, for the first time, that the controversial method is as effective as the prevailing one,” says Dr. Howald. “It sounds like something minor, but for the caregivers, infants and families, it is a statistic that allows for a significant improvement in preterm care. It is another tool, less invasive and less harmful than the treatments used for delicate preterm infants who need resuscitation. To date, because decisions were based on models “Many were unwilling to use this method because they thought it was less effective. Now there is proof. Because we are talking about treatment that most preterm infants will receive at one time or another, this is an important step for everyone.”

To the scientific paper

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