Impact of Different Modes of Noninvasive Ventilation on Regional Oximetry and Hemodynamics in Premature Newborn
Condition: Respiratory Distress Syndrome
MeSH terms: Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Premature Birth
Study type: Observational

Summary: 
      The purpose of this study is to examine the blood flow and the delivery of oxygen to the
      brain and gut in preterm babies while they are supported with two modes of breathing machine
      and compare these two methods to see if one allows for better blood flow to the brain and
      gut.
    

Detailed description: 
      Preterm babies under 32 weeks of gestational age usually needs to be supported with breathing
      machine because of different kinds of problems like lungs immaturity or infection. One type
      of breathing machine support is called CPAP(Continuous Positive Airway Pressure).This
      breathing support machine is connected to the nose to help preterm baby breathe. This machine
      blows air or an air/oxygen mixture through the nose and in to the baby's lung; this helps to
      keep baby's lungs fully open and makes it easier for the baby to breathe. There are two ways
      this machine can help the baby breathe - it can either blow the air/oxygen mixture at the
      same pressure all the time…we call that CPAP, or we can vary the pressure - we call that
      TrPA(Trigger Pressure Assist). Both methods have been in use in neonatal intensive care
      units(NICUs) for several years and both methods help with the breathing of babies.

      The breathing machine (CPAP) makes the lungs better inflated. This inflation might affect the
      ability of the heart to push the blood to the organs through the blood vessels. Also we do
      not know whether there is any difference in the blood flow or oxygen delivery depending
      whether the baby is on CPAP or TrPA.

      We will measure the heart function using Ultrasound (Echocardiography). To measure the
      efficiency of the flow of the blood through the vessels to the organs we will use Near Infra
      Red Spectroscopy (NIRS); this involves applying a sensor to the baby's skin - one on the
      forehead and one on the tummy and connecting the sensors to a machine which can measure the
      oxygen level in the organ under the skin.

      While the baby is on CPAP, we will start monitoring oxygen saturation by applying NIRS
      sensors to the forehead and the abdomen. After 3 hours we will do echocardiography
      (ultrasound of the heart)to see any changes that might happen to the heart and blood vessels
      while the baby is on CPAP. Then, using the same machine, we will change the mode of
      respiratory support to TrPA. After another three hours, we will do another echocardiography
      (ultrasound of the heart), then we will stop NIRS monitoring and change the mode of
      respiratory support back to CPAP.
    

Intervention name(s): Echocardiography; Near Infrared Spectroscopy Monitoring
Intervention type(s): Other; Other
Intervention description(s): Measurement of:
Left ventricular output (LVO).
Right ventricular output (RVO).
Assessment of the Mesenteric Artery Flow.; Measurement of cerebral and mesenteric regional oxygen saturation(rSO2) trends and data while the baby on CPAP or TrPA modes of noninvasive ventilation.
Other intervention name(s): NIRS
Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Newborn infants less than 34 weeks gestational age at birth Requiring CPAP or TrPA as a
        mode of respiratory support
      
Keywords: Neonate; Hemodynamic; Tissue oxygenation; Non invasive ventilation