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In most situations, especially those requiring short term ventilation, discontinuing mechanical ventilation is not too challenging. This process, however, becomes more difficult when dealing with very premature and extremely low birth weight babies as well as those recovering from major respiratory failure, who required prolonged ventilatory support. The process of discontinuing mechanical ventilation in such babies has become a major clinical challenge and constitutes a large proportion of the workload in most neonatal intensive care units.
CASE STUDY 1
Baby MM was born by normal vaginal delivery at 25 weeks’ gestation with a birth weight of 890 g. Mother had received two doses of antenatal steroid. Her membranes had ruptured four days before delivery. The baby’s condition at birth was satisfactory but he was immediately intubated and given prophylactic surfactant. However, he did develop respiratory failure due to hyaline membrane disease and required mechanical ventilation. On day 2, he was commenced on total parenteral nutrition (TPN) and enteral feeds were slowly introduced. On day 7, he developed features of necrotising enterocolitis for which he received conservative treatment for seven days. On day 18, he was noted to have signs of patent ductus arteriosus (PDA) which was treated with a course of indomethacin. Despite this, he needed an increased level of ventilatory support to maintain adequate gas exchange. A repeat echocardiography revealed persistence of a haemodynamically significant PDA which needed surgical ligation on day 26. The immediate postoperative course was complicated with development of pulmonary hypertension which responded quickly to inhaled nitric oxide treatment. However, he remained ventilator dependent and by day 28 was showing signs of chronic lung disease. For this, he was commenced on a 10 day course of dexamethasone (a total dose of 712 μg/kg over 10 days; DART (dexamethasone: a randomized trial), bronchopulmonary dysplasia (BPD) regimen1). On day 34, …