Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 240-241 (doi:10.1542/peds.2007-1163)

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LETTER TO THE EDITOR

Ventilatory Pump Failure and Strategies to Prevent Bronchopulmonary Dysplasia: In Reply

Hany Aly, MD
Department of Newborn Services
George Washington University Hospital and Children's National Medical Center
Washington, DC 20037

I am grateful for the letter from Dr Watchko, which stresses the importance of neuronal respiratory drive, contractile properties of respiratory muscles, and thoracoabdominal mechanics, in addition to parenchymal lung disease in premature infants to improve the experience with the use of continuous positive airway pressure (CPAP). Of course, optimizing all these factors will help infants to breathe easier and avoid the need for tracheal intubation and mechanical ventilation. However, it is important to mention that the benchmark incidence of bronchopulmonary dysplasia (BPD) in very low birth weight infants is 29%, whereas in our recent experience with CPAP the incidence of BPD was only 6%.¹ Similar figures for BPD have been published for the CPAP experience at Columbia University.² Therefore, the use of the currently available CPAP is vastly successful. Our goal is to focus on making these BPD figures universally replicable in all units. Once this milestone is established, efforts should then be focused on optimizing the "ventilatory pump" to further lower BPD to <6%. At the current stage, I find it distracting to focus on different medications and ventilatory approaches while the available CPAP technique can be feasible and successful in our population. Subsequent efforts that can support premature lungs and/or ventilatory pump should be addressed only after passing this first important milestone.

REFERENCES

1. Aly H, Massaro AN, Patel K, El-Mohandes AA. Is it safer to intubate premature infants in the delivery room? Pediatrics. 2005;115 :1660 –1665[Abstract/Free Full Text]
2. Van Marter LJ, Allred EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics. 2000;105 :1194 –1201[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Aly, H. Search for Related Content PubMed Articles by Aly, H. Related Collections Respiratory Tract Social Bookmarking                         What's this?