Science behind use of antenatal corticosteroids, CPAP and surfactant

In this Webinar we will learn about the science behind and physiology of antenatal steroids, continuous positive airway pressure or CPAP & Surfactant
Let us understand and learn How antenatal steroids work, how does CPAP work, and what is the mechanism of working of surfactant. In addition, we will try and learn the synergism between ANS, CPAP & surfactant in management of a preterm neonate with RDS.
Let us begin by realising what is our quantum of preterm births. India has the dubious distinction of having the highest number of preterm births and neonatal deaths due to prematurity. Out of an estimated 2.6 crore live births in India each year, 35 lakh babies are born preterm, and out of these, 3 lakh babies (10% approximately) die due to complications of preterm births
Preterm neonates are vulnerable and Fetal lung immaturity is the principal contributor for neonatal mortality Therefore lung has been the primary focus of strategies to improve the survival of newborn infants Strategies for the prevention and treatment of RDS have been directed towards the acceleration of fetal lung maturation in utero mainly by administering ANS to the mother and CPAP with or without surfactant to neonate
Out of these three potentially useful strategies for the preterm neonate let us learn the science and understand how antenatal steroids work. Antenatal steroids accelerate development of pneumocytes, thus improving lung mechanics (maximizing lung volume and compliance) and thus gas exchange. It increases surfactant production. There is not just induction of surfactant release but also absorption of alveolar fluid and increase of lung antioxidant enzymes; resulting in reduction in RDS, reduction in Intraventricular hemmorhage, Necrotising enterocolitis, systemic sepsis and mortality.
After having learnt about Antenatal steroids Let us now talk about CPAP. First thing in CPAP is to know What is CPAP. Well CPAP as it is abbreviated is continuous positive airway pressure --- which really refers to aapplication of continuous pressure to the airways during both inspiration and expiration in a spontaneously breathing baby
Now we will try and understand what does CPAP do? Well CPAP keeps the alveoli open by providing constant airway pressure, as also splints the airways so that they do not collapse. These thus increases the functional residual capacity (FRC) of the lungs resulting in better breathing and better gas exchange culminating in lesser lung injury.
  • Introduction...
  • 1. What shall we l...
  • 2. Quantum of prem...
  • 3. Vulnerability i...
  • 4. How do antenata...
  • 5. What is CPAP?...
  • 6. What does CPAP ...
  • 7. PVR increases a...
  • 8. CPAP and Surfac...
  • 9. Surfactant prod...
  • 10. What did we le...
 

Introduction

Dr. SUSHMA NANGIA
MD, DM (Neonatology)

Director Professor & Head
Department of Neonatology
LHMC & Kalawati Saran Children’s Hospital, New Delhi

1. What shall we learn?

â–º How do Antenatal Steroids (ANS) work?

â–º How does CPAP work?

â–º How does surfactant work?

â–º Synergistic action of ANS, CPAP and surfactant

2. Quantum of prematurity

India has the
      ♦ Highest number of preterm births and
      ♦ Highest number of neonatal deaths due to prematurity

â–º Births - 2.6 crore live births/ year

â–º Preterm births - 35 lakh/ year

â–º Preterm deaths - 3 lakh babies (10%)

3. Vulnerability in prematurity

â–º Fetal lung immaturity - principal contributor for neonatal
    mortality

â–º Primary focus of strategies to improve the survival - lung

â–º Strategy for prevention and treatment of RDS
      ♦ Acceleration of fetal lung maturation by ANS therapy to the
        mother
      ♦ CPAP to the neonate
      ♦ Surfactant to neonate

4. How do antenatal steroids work?

â–º Accelerates development of pneumocytes, improve lung
    mechanics (maximal lung volume, compliance), gas exchange

â–º Increases surfactant production

â–º Induction of surfactant release, absorption of alveolar fluid,
    increases lung antioxidant enzymes

â–º Reduction in RDS, reduction in intraventricular hemorrhage,
    necrotizing enterocolitis, mortality, systemic sepsis and
    mortality

5. What is CPAP?

CPAP – Continuous Positive Airway Pressure
Application of continuous pressure during
both inspiration and expiration in a
spontaneously breathing baby

6. What does CPAP do?

â–ºProvides constant airway pressure
      ♦ Keeps the alveoli open
      ♦ Keeps airways splinted & open (improves FRC)



â–º Leads to
      ♦ Better breathing
      ♦ Better gas exchange – Less lung injury

7. PVR increases at lung volumes below and above FRC

8. CPAP and Surfactant Together!

9. Surfactant production

10. What did we learn?

â–º CPAP is safe as it causes less lung injury

â–º Give optimal CPAP to open the lung at FRC as PVR is least
    with maximum blood flow

â–º Surfactant and CPAP together is beneficial in RDS

â–º CPAP will give maximum dividends if used with antenatal
    steroids and early surfactant when required

â–º Good delivery room care and use early CPAP

â–º Acceptance by team