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The first 24 hours
Born prematurely at 28 weeks gestation, Lindsay’s lungs and heart are not ready for life outside the womb.
Immediately following birth her breathing is labored, so the team quickly transfers her to the NICU to be treated for respiratory distress syndrome (RDS). The staff is hopeful that she will not need to be intubated, so they rely on the Puritan Bennett™ 980 ventilator NIV+ software to estimate how much pressure is being delivered into her lungs and manage any NIV leaks.
To assess her progress, the team begins continuous monitoring for apnea, bradycardia, and desaturation (AB&D) events.
24 hours & after
Lindsay remains tachycardic with intermittent desaturations and a widening pulse pressure — leading the team to also suspect a patent ductus arteriosus (PDA). Lindsay’s RN notes that she still has no weight gain, and multiple sweaty and damp swaddle changes overnight. Her neonatologist detects a heart murmur and begins cerebral and renal monitoring for diastolic hypotension and cardiopulmonary instability while she awaits the results of an echocardiogram.
During one of the frequent bedside visits, a respiratory therapist recognizes subtle tachypnea, an expiratory grunt, retractions, and nasal flaring in addition to desaturation events. By estimating pressure at the patient end of the cannula with NIV+, the respiratory therapist knows that her lungs are receiving the maximum level of NIV support and notifies the neonatologist. A blood gas is ordered and confirms the need to escalate Lindsay to intubation and mechanical ventilation. Lindsay gets intubated and is placed on the SonarMed™ airway management system to see real time movement and obstructions within the endotracheal tube during intubation.
Respiratory distress syndrome (RDS) occurs in premature babies whose lungs are not fully developed nor producing enough surfactant in the lungs.
Lindsay is supported with a Puritan Bennett™ 980 ventilator with NIV+ software and supplemental oxygen. She is later escalated to intubation with an endotracheal tube and supported with Puritan Bennett 980 ventilator NeoMode 2.0 software that tightly controls the delivery volumes to her tiny lung capacity.
A multipurpose ventilator for noninvasive and invasive ventilation to help clinicians manage neonatal respiratory care:
Designed to estimate end inspiratory and end expiratory pressures at the patient interface. This provides valuable information to the clinician and may reduce the uncertainty around effective pressure delivery to the patient. It also provides a robust means of determining disconnect, especially when leaks are present.
Helps clinicians provide ventilatory support to neonates weighing as little as 300 grams by delivering tidal volumes as small as 2 mL. NeoMode 2.0 software was developed specifically for neonates to address and improve the issues critical to their care and safety, such as accurate breath delivery, responsive triggering, lower elevated oxygen preset for procedures, effective alarm management, and automatic leak compensation.
Please refer to the instructions for use for the indications, contraindications, warnings, risks, and precautions associated with the Puritan Bennett™ 980 ventilator and software referenced in these materials.
The airways of premature patients are especially tiny and fragile and there are concerns of small tube moments that can cause unplanned extubation. Even one unplanned extubation (UEs) poses a significant safety concern — and are the most common adverse event related to intubations.4
Lindsay’s RT uses a Shiley™ cuffless oral/nasal endotracheal tube with SonarMed™ airway monitoring system to provide real-time visualizations to monitor endotracheal tube (ETT) position and patency. These products help ensure the tube is right where it is supposed to be including when moving Lindsay to her mom’s chest for bonding skin-to-skin time.
Designed with anatomically based print rings, a shortened TaperGuard™ cuff, and without a Murphy eye to help clinicians with the following:
The SonarMed™ airway monitoring system should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment.
Patent ductus arteriosus (PDA) is the most common cardiac condition in preterm infants.8 If left untreated, a large PDA can allow poorly oxygenated blood to flow in the wrong direction leading to a variety of complications.
Lindsay’s cardiologist confirms a PDA and so her neonatologist treats her intravenously with Indocin and monitors her regional oxygen saturation (rSO2) in both her cerebral and renal tissues.
Designed to help quickly identify desaturation events and improve the clinician’s ability to intervene sooner. Because seconds matter.
A soft, small sensor designed for fragile neonatal skin for use anywhere on the body. INVOS™ infant regional saturation sensors are applied to the skin’s surface, and are user and patient friendly, making monitoring of ischemic threats to the brain and body possible. By reporting venous weighted regional hemoglobin oxygen saturation (rSO2) in tissue directly beneath the sensor, the INVOS™ regional oximetry system reflects oxygen remaining after tissue demand has been met.
The INVOS™ 7100 regional oximetry system should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment
Apnea, bradycardia, and desaturation (AB&D) events are common in preterm babies with immature respiratory systems. But for neonates requiring long-term monitoring, skin injury is a concern.
To mitigate the risk of skin breakdown, Lindsay’s nurse uses Nellcor™ SpO₂ nonadhesive sensors to monitor AB&Ds.
The Nellcor™ nonadhesive sensors are made of a soft, pliable, low-profile foam material that gives it “stiction” to help keep the sensor in place without adhesives. The sensors fasten easily with a small hook and loop strap. Nellcor™ nonadhesive sensors are ideal for patients with special skin needs.
The Nellcor™ pulse oximetry monitoring system should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment.
“A mother’s womb is the ideal environment for a developing baby, but early arrivals sometimes cannot be avoided. When a baby is born prematurely, their still developing bodies are extremely vulnerable. Respiratory distress is one of the most common problems neonates encounter within the first few days of life.10
In Lindsay’s case, with the help of patient monitoring, we were quickly alerted to signs of distress which eventually led to the need to escalate to intubation. Intubation poses additional risk on a neonate’s fragile airways. Advancements in patient airway monitoring helps us correctly position ETT and avoid unplanned extubations.”
– Respiratory therapist, NICU†
Support & partnerships
The NICU team is more than just a group of highly trained and specialized medical professionals. It’s a genuine smile at the sight of a milestone achieved. It’s an emotional and sometimes heartbreaking end to a shift. It’s a supportive shoulder and life coach to a concerned parent struggling with their new reality. It is a family. At Medtronic we strive to be more than just a medical technology company; we aim to be a supportive member of that family.
† These narratives feature fictional patients, based on real clinical scenarios and product use. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation. Changes in a patient’s disease and/or medications may alter the efficacy of the therapy, or product features. Results may vary.
Keszler M. Mechanical ventilation strategies. Seminars in Fetal and Neonatal Medicine. 2017;22(4):267-274.
Dargaville PA, Tingay DG. Lung protective ventilation in extremely preterm infants. Journal of Pediatrics and Child Health. 2012:48(9):740-746.
Puritan Bennett™ 980 ventilator operations manual.
Hatch LD, Scott TA, Slaughter JC, et al. Outcomes, resource use, and financial costs of unplanned extubations in preterm infants. Pediatrics. 2020;145(6):e20192819. doi:10.1542/peds.2019-2819.
Roddy DJ, Spaeder MC, Pastor W, Stockwell DC, Klugman D. UEs in Children: Impact on Hospital Cost and Length of Stay. Pediatr Crit Care Med. 2015;16(6):572–575.
Galiote JP, Ridoré M, Carman J, et al. Reduction in unintended extubations in a level IV neonatal intensive care unit. Pediatrics. 2019;143(5):e20180897.
Alitimier L, Phillips R. The neonatal integrative developmental care model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn and Infant Nursing Reviews. 2016:16:230-244.
Oncel MY, Erdeve O. Safety of therapeutics used in management of patent ductus arteriosus in preterm infants. Curr Drug Saf. 2015;10(2):106-12. doi: 2174/1574886309999141030142847. PMID: 25323589.
Valerie Y. Chock, Laura A. Rose, Jeanet V. Mante, and Rajesh Punn. Near-infrared spectroscopy for detection of a significant patent ductus arteriosus.. Pediatric Research, 2016;80(5): 675-680.
Parkash A., Haider N., Khoso Z.A., Shaikh A.S. Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. JPMA. 2015;65:771–775.