Angelika Berger

Aim Respiratory distress syndrome often necessitates endotracheal surfactant administration in extremely preterm infants. Our study aimed to explore a multi‐modal simulation tool for investigating treatment strategies in ex vivo sheep lungs during spontaneous breathing. Methods An electromechanical lung simulator (xPULM) mimicking spontaneous breathing was coupled with a non‐aerated premature sheep lung, replicating a premature respiratory system. Changes in tidal volume for different positive end‐expiratory pressure (PEEP) levels prior to and after either bolus or nebulised surfactant administration were compared. Results In two preterm sheep lungs, we observed a progressive decline in tidal volume with increasing PEEP levels prior to surfactant delivery from 0.30 ± 0.01 mL at zero PEEP to 0.04 ± 0.01 mL at 15 cmH2O PEEP. Our measurements showed that both bolus ( p < 0.05) and nebulised ( p < 0.05) surfactant administration resulted in a significant increase in tidal volume, with no significant difference ( p = 0.71) between the two methods. Conclusion The experimental setup demonstrated the feasibility of xPULM for investigating the effectiveness of different PEEP levels and modes of surfactant administration with respect to tidal volume in premature sheep lungs. The lack of adequate lung water resorption in our model warrants further investigations.

Aim To investigate the impact of the level of pain experienced by infants born preterm on neurodevelopmental outcomes during their stay in a neonatal intensive care unit. Method In this retrospective data analysis we included all surviving infants born preterm with a gestational age between 23 and 32 weeks from 2011 to 2015, who were assessed using the Neonatal Pain, Agitation, and Sedation Scale and examined at 1 year of age using the Bayley Scales of Infant Development. We excluded all infants who had suffered severe neurological morbidities and undergone surgical interventions. Results A total of 196 infants born preterm were included in the analyses: 105 in the ‘no pain group’ and 91 in the ‘pain group’. Significant differences between the groups were detected for both mental and motor development ( p = 0.003, 95% confidence interval [CI] 2.23–10.92; p = 0.025, 95% CI 0.64–9.78). The results remained significant after controlling for other important medical conditions ( p = 0.001, 95% CI −19.65 to −5.40; p = 0.010, 95% CI −16.18 to −2.29). Interpretation Neonatal pain exposure was associated with altered neurodevelopmental outcomes of infants born very preterm at a corrected age of 12 months. This observation highlights the importance of adequate pain management to reduce the risk of poor neurodevelopmental outcomes in these vulnerable patients.