Kapustina O. Optimization of positive pressure ventilation in term newborns with severe asphyxia at birth

The study reflects results of investigation of features of acute period for hypoxic-ischemic encephalopathy (HIE) in term newborns with moderate and severe respiratory failure needed in ventilation support. Features of severity for HIE, dynamics of consciousness and cerebral perfusion depending on moderate or severe respiratory insufficiency were studied. We obtained evidences that indications for starting of positive pressure ventilation in acute period for hypoxic-ischemic encephalopathy include not only severe respiratory insufficiency but neurologic deterioration, seizures and low score by modified Glasgow Coma Scale for infants less then 9 points. Study defines that concomitant ARDS complicates unconsciousness, decreases cerebral perfusion during acute period and requires modified positive pressure ventilation. Post-hoc analysis did not discover a negative correlation between parameters of respiratory support and brain perfusion. Thereby we can conclude that positive pressure ventilation in appropriate modes is safe in full term newborns with moderate and severe HIE. Considering obtained correlations cerebral blood flow autoregulation is proved in term babies and it was dependant on non-invasive measured cardiac output not on mean blood pressure. Advisability of respiratory support during acute period of HIE was sustained. Basing on inverse proportion between duration of positive pressure ventilation and mortality in neonates with severe HIE we can affirm neuroprotective properties of proper positive pressure ventilation. Indications for ventilation withdrawal in newborns with HIE include conscious level score more then 10 points by modified Glasgow Coma Scale for infants, seizures absence and regular spontaneous breathing pattern.