The effect of respiratory management on neurodevelopmental outcome in preterm infants

There is growing evidence that invasive mechanical ventilation in preterm infants induces long-term pulmonary morbidity such as bronchopulmonary dysplasia as well as neurodevelopmental sequelae. Therefore, this thesis aims to assess the effect of a restricted respiratory management policy on neurodevelopmental outcome in preterm infants. Based on this thesis, several conclusions can be drawn. First, this thesis demonstrates that the implementation of a non-invasive respiratory support policy is feasible and might be associated with improved neurodevelopmental outcome even in extremely preterm infants. This is supported by our finding that – in this new era of non-invasive respiratory management – every additional day of invasive mechanical ventilation is associated with an increased risk of adverse neurodevelopmental outcome at two years of age. Second, bronchopulmonary dysplasia is associated with an adverse neurodevelopmental outcome at two and five years of age. In addition, increasing severity results in an increased risk of NDI. Similar to the general population, the correlation between two and five years neurodevelopmental outcome is only fair, emphasizing the importance of following up this high-risk population to at least 5 years of age. Finally, there is only limited evidence supporting the use of a higher dose of caffeine and doxapram in the treatment of apnea of prematurity