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Neonatology pp 971-993 | Cite as

Continuous Positive Airways Pressure and Other Noninvasive Respiratory Techniques in Newborns

  • Fabrizio Sandri
  • Gina Ancora
  • Gianluca Lista
  • Luc J. I. Zimmermann
Reference work entry

Abstract

Continuous positive airways pressure (CPAP) is a method of assisted respiration that consists of the application of continuous positive pressure to a spontaneously breathing patient’s airways throughout the entire respiratory cycle. The first use of a CPAP was in the 1930s (Poulton EP, Oxon DM, Lancet 228:981–983, 1936; Bullowa JGH, The management of the Pneumonias. Oxford University Press, New York, 1937; Barach AL, Martin J, Eckman M, Proc Am Soc Clin Invest 16:664–680, 1937), but its first notable application in the neonatal field was in 1971 when CPAP was used in the treatment of RDS (respiratory distress syndrome) in spontaneously breathing newborns undergoing tracheal intubation (Gregory GA, Kittermann JA, Phibbs RH et al. N Engl J Med 284:1333–1340, 1971). Nowadays, nasal CPAP (N-CPAP) is considered a valid approach in the management of respiratory failure of the preterm infant from birth reducing occurrence of bronchopulmonary dysplasia (BPD) and death, without increasing risk of neurological damage.

References

  1. AARC (American Association for Respiratory Care) (1994) Application of continuous positive airway pressure to neonates via nasal prongs or nasopharyngeal tube. Respir Care 39:817–823Google Scholar
  2. Agostino R, Orzalesi M, Nodari S et al (1973) Continuous positive airway pressure (CPAP) by nasal cannula in the respiratory distress syndrome (RDS) of the newborn. Pediatr Res 7:50Google Scholar
  3. Ahluwalia JS, White DK, Morley CJ (1998) Infant flow driver or single prong nasal continuous positive airway pressure: short term physiological effects. Acta Pediatr 87:325–327CrossRefGoogle Scholar
  4. Ahumada CA, Goldsmith JP (1996) Continuous distending pressure. In: Goldsmith JP, Karotkin EH (eds) Assisted ventilation of the neonate. WB Saunders, Philadelphia, pp 151–165Google Scholar
  5. Aranda JV, Turmen T (1979) Methylxanthines in apnoea of prematurity. Clin Perinatol 6:87–108PubMedCrossRefGoogle Scholar
  6. Avery ME, Mead J (1959) Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97:517–523Google Scholar
  7. Avery ME, Tooley WH, Keller JB et al (1987) Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 79:26–30PubMedGoogle Scholar
  8. Bancalari E, Sinclair JC (1991) Mechanical ventilation. In: Sinclair JC, Brachen MB (eds) Effective care of the newborn infant. Oxford University Press, Oxford, pp 200–220Google Scholar
  9. Barach AL, Martin J, Eckman M (1937) Positive pressure respiration and its application to the treatment of acute pulmonary edema and respiratory obstruction. Proc Am Soc Clin Invest 16:664–680Google Scholar
  10. Beasley JM, Jones SEF (1981) Continuous positive airway pressure in bronchiolitis. Br Med J 283:1506–1508CrossRefGoogle Scholar
  11. Blennow M, Jonsson B, Dahlstrom A et al (1999) Lung function in premature infants can be improved. Surfactant therapy and CPAP reduce the need of respiratory support. Lakartidningen 96:1571–1576PubMedGoogle Scholar
  12. Bucci G, Marzetti G, Picece-Bucci S et al (1974) Phrenic nerve palsy treated by continuous positive pressure breathing by nasal cannula. Arch Dis Child 49:230–232PubMedPubMedCentralCrossRefGoogle Scholar
  13. Bullowa JGH (1937) The management of the pneumonias. Oxford University Press, New YorkGoogle Scholar
  14. Burch K, Rhine W, Baker R et al (2003) Implementing potentially better practices to reduce lung injury in neonates. Pediatrics 111:e432–e436PubMedGoogle Scholar
  15. Caliumi-Pellegrini G, Agostino R, Orzalesi M et al (1974) Twin nasal cannula for administration of continuous positive airway pressure to newborn infants. Arch Dis Child 49:228–230PubMedPubMedCentralCrossRefGoogle Scholar
  16. Cohen G, Henderson-Smart D (1986) Upper airway stability and apnoea during nasal occlusion in newborn infants. J Appl Physiol 60:1511–1517PubMedCrossRefGoogle Scholar
  17. Cordero L, Ayers LW, Davis K (1997) Neonatal airway colonization with gram-negative bacilli: association with severity of bronchopulmonary dysplasia. Pediatr Infect Dis J 16:18–23PubMedCrossRefGoogle Scholar
  18. Courtney SE, Pyon KH, Saslow JG et al (2001) Lung recruitment and breathing pattern during variable versus continuous positive airway pressure in premature infants. An evaluation of three devices. Pediatrics 197:304–308CrossRefGoogle Scholar
  19. Davis PG, Henderson-Smart DJ (2000) Nasal CPAP immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 3:CD000143Google Scholar
  20. Davis AJ, Jobe AH, Häfner D et al (1998) Lung function in premature lambs and rabbits treated with a recombinant SP-C surfactant. Am J Respir Crit Care Med 157(2):553–559PubMedCrossRefGoogle Scholar
  21. Dunn MS, Kaempf J, de Klerk A et al (2011) Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 128(5):e1069–e1076PubMedCrossRefGoogle Scholar
  22. Elgellab A, Riou Y, Abbazine A et al (2001) Effects of nasal continuous airway positive pressure (NCPAP) on breathing pattern in spontaneously breathing premature newborn infants. Intensive Care Med 27:1782–1787PubMedCrossRefGoogle Scholar
  23. Finer NN, Waldemar AC, Duara S et al (2004) Delivery room continuous positive airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial. Pediatrics 114:651–657PubMedCrossRefGoogle Scholar
  24. Finer NN, Carlo WA, Walsh MC et al (2010) Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 362(21):1970–1979PubMedCrossRefGoogle Scholar
  25. Fischer HS, Bührer C (2013) Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 132(5):e1351–e1360PubMedCrossRefGoogle Scholar
  26. Fox WW, Berman LS, Downes JJ Jr, Peckham GJ (1975) The therapeutic application of end-expiratory pressure in the meconium aspiration syndrome. Pediatrics 56:214–217PubMedGoogle Scholar
  27. Fox WW, Schwartz JG, Shaffer TH (1981) Successful extubation of neonates: clinical and physiological factors. Crit Care Med 9:823–826PubMedCrossRefGoogle Scholar
  28. Gaon P, Lee S, Hannan S et al (1999) Assessment of effect of nasal continuous positive pressure on laryngeal opening using fibre optic laryngoscopy. Arch Dis Child Fetal Neonatal Ed 80:F230–F232PubMedPubMedCentralCrossRefGoogle Scholar
  29. Gauda EB, Miller MJ, Carlo W et al (1987) Genioglossus response to airway occlusion in apneic versus non-apneic infants. Pediatr Res 22:683–687PubMedCrossRefGoogle Scholar
  30. Gerhardt T, Bancalari E (1980) Chestwall compliance in full-term and premature infants. Acta Pediatr Scand 69:359–364CrossRefGoogle Scholar
  31. Gherini S, Peters RM, Virgilio RW (1979) Mechanical work on the lungs and work of breathing with positive end expiratory pressure and continuous positive airway pressure. Chest 76:251–256PubMedCrossRefGoogle Scholar
  32. Gittermann MK, Fusch C, Gittermann AR et al (1997) Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants. Eur J Pediatr 156:384–388PubMedCrossRefGoogle Scholar
  33. Gizzi C, Montecchia F, Panetta V et al (2015) Is synchronised NIPPV more effective than NIPPV and NCPAP in treating apnoea of prematurity (AOP)? A randomised cross-over trial. Arch Dis Child Fetal Neonatal 100(1):F17–F23CrossRefGoogle Scholar
  34. Goldman SL, Brady JP, Bchir MB et al (1979) Increased work of breathing associated with nasal prongs. Pediatrics 64:160–164PubMedGoogle Scholar
  35. Greenough A (1996) Transient tachypnoea of the newborn. In: Greenough A, Roberton NRC, Milner AD (eds) Neonatal respiratory disorders. Arnold, London, pp 280–285Google Scholar
  36. Greenough A, Roberton NRC (1996) Respiratory distress syndrome. In: Greenough A, Roberton NRC, Milner AD (eds) Neonatal respiratory disorders. Arnold, London, pp 238–279Google Scholar
  37. Gregory GA (1986) Continuous positive airways pressure. In: Thibeault DW, Gregory GA (eds) Neonatal pulmonary care, 2nd edn. Appleton & Lange, Norwalk, p 355Google Scholar
  38. Gregory GA, Kittermann JA, Phibbs RH et al (1971) Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med 284:1333–1340PubMedCrossRefGoogle Scholar
  39. Gupta S, Sinha SK, Tin W, Donn SM (2009) A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus infant flow driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr 154:645–650PubMedCrossRefGoogle Scholar
  40. Harrison VC, de Heese Hde V, Klein M (1968) The significance of grunting in hyaline membrane disease. Pediatrics 41:549–559PubMedGoogle Scholar
  41. Henderson-Smart DJ, Steer P (2001) Methyl-xanthine treatment for apnea in preterm infants. Cochrane Database Syst Rev 3:CD000140Google Scholar
  42. Higgins RD, Richter SE, Davis JM (1991) Nasal continuous positive airway pressure facilitates extubation of very low birth weight neonates. Pediatrics 88:999–1003PubMedGoogle Scholar
  43. Hooper SB, Siew ML, Kitchen MJ (2015) Respiratory transition in the newborn: a three phase process. Arch Dis Child Fetal Neonatal Ed 101(3):F266–F271PubMedCrossRefGoogle Scholar
  44. Horbar JD, McAuliffe TL, Adler SM et al (1988) Variability in 28- day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units. Pediatrics 82:554–559PubMedGoogle Scholar
  45. Jacobsen T, Gronvall J, Petersen S et al (1993) “Minitouch” treatment of very low birth weight infants. Acta Pediatr 82:934–938CrossRefGoogle Scholar
  46. Jonsson B, Katz-Salamon M, Faxelius G et al (1997) Neonatal care of very low birth weight infants in special care units and neonatal intensive care units in Stockholm. Early nasal continuous positive airway pressure versus mechanical ventilation: gains and losses. Acta Pediatr Suppl 419:4–10CrossRefGoogle Scholar
  47. Jonzon A (1991) Indications for continuous positive airway pressure and respiratory therapy. Int J Technol Assess Health Care 7(Suppl 1):26–30PubMedCrossRefGoogle Scholar
  48. Kamper J, Ringsted C (1990) Early treatment of idiopathic respiratory distress syndrome using binasal continuous positive airway pressure. Acta Pediatr Scand 79:581–586CrossRefGoogle Scholar
  49. Kamper J, Wulff K, Larsen C et al (1993) Early treatment with nasal continuous positive airway pressure in very low birth weight infants. Acta Pediatr 82:193–197CrossRefGoogle Scholar
  50. Karlberg P (1960) The adaptive changes in the immediate postnatal period, with particular reference to respiration. J Pediatr 56:585–604PubMedCrossRefGoogle Scholar
  51. Kattwinkel J (1977) Neonatal apnoea: pathogenesis and therapy. J Pediatr 90:342–347PubMedCrossRefGoogle Scholar
  52. Kattwinkel J, Fanaroff A, Cha C et al (1973) Controlled trial of continuous positive airway pressure (CPAP) in RDS and a simplified application by the nasal route. Pediatr Res 7:396Google Scholar
  53. Kavvadia V, Greenough A, Dimitriou G (2000) Effect on lung function of continuous positive airway pressure administered either by infant flow driver or a single nasal prong. Eur J Pediatr 159:289–292PubMedCrossRefGoogle Scholar
  54. Klausner JF, Lee AY, Hutchinson AA (1996) Decreased imposed work with a new nasal continuous positive airway pressure device. Pediatr Pulmonol 22:188–194PubMedCrossRefGoogle Scholar
  55. Kribs A, Hummler H (2016) Ancillary therapies to enhance success of non-invasive modes of respiratory support – approaches to delivery room use of surfactant and caffeine? Semin Fetal Neonatal Med 21(3):212–218PubMedCrossRefGoogle Scholar
  56. Kurz H (1999) Influence of nasopharyngeal CPAP on breathing pattern and incidence of apnoeas in preterm infants. Biol Neonate 76:129–133PubMedCrossRefGoogle Scholar
  57. Lam BC (1999) Surfactant lavage for the management of severe meconium aspiration syndrome. Biol Neonate 76(Suppl 1):10–14PubMedCrossRefGoogle Scholar
  58. Lemyre B, Davis PG, De Paoli AG et al (2017) Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2:CD003212.  https://doi.org/10.1002/14651858.CD003212.pb3)CrossRefPubMedGoogle Scholar
  59. Leone RJ, Krasna IH (2000) “Spontaneous” neonatal gastric perforation: is it really spontaneous? J Pediatr Surg 35:1066–1069PubMedCrossRefGoogle Scholar
  60. Levy J, Habib RH, Liptsen E et al (2006) Prone versus supine positioning in the well preterm infant: effects on work of breathing and breathing patterns. Pediatr Pulmonol 41:754–758PubMedCrossRefGoogle Scholar
  61. Lindner W, Vossbeck S, Hummler H et al (1999) Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Pediatrics 103:961–967PubMedCrossRefGoogle Scholar
  62. Loftus BC, Ahn J, Haddad J (1994) Neonatal nasal deformities secondary to nasal continuous positive airway pressure. Laryngoscope 104:1019–1022PubMedCrossRefGoogle Scholar
  63. Lundstrom KE (1996) Initial treatment of preterm infants–continuous positive airway pressure or ventilation? Eur J Pediatr 155(Suppl 2):S25–S29PubMedCrossRefGoogle Scholar
  64. Martin RJ, Nearman HS, Katona PG et al (1977) The effect of a low continuous positive airway pressure on the reflex control of respiration in the preterm infant. J Pediatr 90:976–981PubMedCrossRefGoogle Scholar
  65. McNamara F, Sullivan CE (1997) Nasal CPAP treatment in an infant with respiratory syncitial virus-associated apnoea. Pediatr Pulmonol 24:218–221PubMedCrossRefGoogle Scholar
  66. Miller MJ, Carlo WA, Martin RJ (1985) Continuous positive airway pressure selectively reduces obstructive apnoea in preterm infants. J Pediatr 106:91–94PubMedCrossRefGoogle Scholar
  67. Miller RW, Pollack MM, Murphy TM et al (1986) Effectiveness of continuous positive airway pressure in the treatment of bronchomalacia in infants: a bronchoscopic documentation. Crit Care Med 14:125–127PubMedCrossRefGoogle Scholar
  68. Miller MJ, DiFiore JM, Strohl KP et al (1990) Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants. J Appl Physiol 68:141–146PubMedCrossRefGoogle Scholar
  69. Moa G, Nilsson K (1993) Nasal continuous positive airway pressure: experiences with a new technical approach. Acta Pediatr 82:210–211CrossRefGoogle Scholar
  70. Moa G, Nilsson K, Zetterstrom H et al (1988) A new device for administration of nasal continuous positive airway pressure in the newborn: an experimental study. Crit Care Med 16:1238–1242PubMedCrossRefGoogle Scholar
  71. Morley C (1999) Continuous distending pressure. Arch Dis Child Fetal Neonatal Ed 81:F152–F156PubMedPubMedCentralCrossRefGoogle Scholar
  72. Morley CJ, Davis PG, Doyle LW et al (2008) Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 358:700–708PubMedCrossRefGoogle Scholar
  73. Mosca F, Colnaghi M, Castoldi F (1996) Lung lavage with a saline volume similar to functional residual capacity followed by surfactant administration in newborns with severe meconium aspiration syndrome. Intensive Care Med 22:1412–1413PubMedCrossRefGoogle Scholar
  74. Pape KE, Armstrong DL, Fitzhardinge PM (1976) Central nervous system pathology associated with mask ventilation in the very low birth weight infant: a new etiology for intracerebellar hemorrhages. Pediatrics 58:473–483PubMedGoogle Scholar
  75. Payne NR, LaCorte M, Karna P et al (2006) Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative. Pediatrics 118:S73–S77PubMedCrossRefGoogle Scholar
  76. Pedersen JE, Nielsen K (1994) Oropharyngeal and esophaegeal pressure during mono-and binasal CPAP in neonates. Acta Pediatr 83:143–149CrossRefGoogle Scholar
  77. Perlman J, Thach B (1988) Respiratory origin of fluctuations in arterial blood pressure in premature infants with respiratory distress syndrome. Pediatrics 81:399–403PubMedGoogle Scholar
  78. Poulton EP, Oxon DM (1936) Left-sided heart failure with pulmonary edema: its treatment with the “pulmonary plus pressure machine”. Lancet 228:981–983CrossRefGoogle Scholar
  79. Rasanen J, Leijala M (1991) Breathing circuit respiratory work in infants recovering from respiratory failure. Crit Care Med 19:31–35PubMedCrossRefGoogle Scholar
  80. Roberton NRC (1993) Does CPAP work when it really matters? Acta Pediatr 82:206–207CrossRefGoogle Scholar
  81. Robertson NJ, McCarthy LS, Hamilton PA, Moss ALH (1996) Nasal deformities resulting from flow driver continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 75:F209–F212PubMedPubMedCentralCrossRefGoogle Scholar
  82. Sahni R, Schiaratura M, Polin RA (2016) Strategies for the prevention of continuous positive airway pressure failure. Semin Fetal Neonatal Med 21(3):196–203PubMedCrossRefGoogle Scholar
  83. Sandri F, Ancora G, Rinaldi M et al (1999) Incidence of intact survival in a group of ELBWI and permissive hypercapnia. Pediatr Res 45:223ACrossRefGoogle Scholar
  84. Sandri F, Ancora G, Lanzoni A et al (2004) Prophylactic nasal continuous positive airways pressure in newborns of 28–31 weeks gestation: multicentre randomised controlled clinical trial. Arch Dis Child Fetal Neonatal Ed 89:F394–F398PubMedPubMedCentralCrossRefGoogle Scholar
  85. Sandri F, Plavka R, Ancora G et al (2010) Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 125:e1402–e1409PubMedCrossRefGoogle Scholar
  86. Schmidt B, Roberts RS, Davis P et al (2006) Caffeine therapy for apnea of prematurity. N Engl J Med 355:958–959CrossRefGoogle Scholar
  87. Schmölzer GM, Kumar M, Pichler G et al (2013) Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 347:f5980PubMedPubMedCentralCrossRefGoogle Scholar
  88. Schmolzer GM, Kumar M, Aziz K et al (2014) Sustained inflation versus positive pressure ventilation at birth: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 100(4):F361–F368PubMedCrossRefGoogle Scholar
  89. Schulze A, Madler HJ, Gehrhardt B et al (1990) Titration of continuous positive airway pressure by the pattern of breathing: analysis of flow-volume-time relationships by a non-invasive computerized system. Pediatr Pulmonol 8:96–103PubMedCrossRefGoogle Scholar
  90. Smedsaas-Lofvemberg A, Nilsson K, Moa G et al (1999) Nebulization of drugs in a nasal CPAP system. Acta Paediatr 88:89–92CrossRefGoogle Scholar
  91. So BH, Tamura M, Mishina J et al (1995) Application of nasal continuous positive airway pressure to early extubation in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 72:F191–F193PubMedPubMedCentralCrossRefGoogle Scholar
  92. Soong WJ, Hwang B, Tang RB (1993) Continuous positive airway pressure by nasal prongs in bronchiolitis. Pediatr Pulmonol 16:163–166PubMedCrossRefGoogle Scholar
  93. Stevens TP, Blennow M, Myers EH, Soll R (2007) Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 3:CD003063Google Scholar
  94. Sweet DG, Carnielli V, Greisen G et al (2017) European consensus guidelines on the management of respiratory distress syndrome – 2016 update. Neonatology 111:107–125CrossRefPubMedGoogle Scholar
  95. Tanswell AK, Clubb RA, Smith BT et al (1980) Individualized continuous distending pressure applied within 6 hours of delivery in infants with respiratory distress syndrome. Arch Dis Child 55:33–39PubMedPubMedCentralCrossRefGoogle Scholar
  96. Tarnow-Mordi WO, Sutton P, Wilkinson AR (1986) Inadequate humidification of respiratory gases during mechanical ventilation of the newborn. Arch Dis Child 61:698–700PubMedPubMedCentralCrossRefGoogle Scholar
  97. Te Pas AB, Siew M, Wallace MJ et al (2009) Establishing functional residual capacity at birth: the effect of sustained inflation and positive end-expiratory pressure in a rabbit model. Pediatr Res 65(5):537–541CrossRefGoogle Scholar
  98. Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol 65:2124–2131PubMedCrossRefGoogle Scholar
  99. Verder H, Robertson B, Greisen G et al (1994) Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. N Engl J Med 331:1051–1055PubMedCrossRefGoogle Scholar
  100. Verder H, Albertsen P, Ebbesen F et al (1999) Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation. Pediatrics 103:e24PubMedCrossRefGoogle Scholar
  101. Vert P, Andre M, Silbout M (1973) Continuous positive airway pressure and hydrocephalus. Lancet 302:319CrossRefGoogle Scholar
  102. Walsh MC, Wilson-Costello D, Zadell A et al (2003) Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol 23:451–456PubMedCrossRefGoogle Scholar
  103. Wilkinson D, Andersen C, O’Donnell CP et al (2016) High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev 2:CD006405.  https://doi.org/10.1002/14651858.CD006405.pub3. ReviewCrossRefPubMedGoogle Scholar
  104. Wilson SL, Thach BT, Brouillette RT et al (1980) Upper airway patency in the human infant: influence of airway pressure and posture. J Appl Physiol Respir Environ Exerc Physiol 48:500–504PubMedGoogle Scholar
  105. Wright CJ, Polin RA, Kirpalani H (2016) Continuous positive airway pressure to prevent neonatal lung injury: how did we get here, and how do we improve? J Pediatr 173:17–24.e2PubMedCrossRefGoogle Scholar
  106. Wylie J, Perlman JM, Kattwinkel J et al (2015) Part 7: neonatal resuscitation:2015 international consensus on cardiopulmonary resuscitation and emergency. Cardiovascular care science with treatment recommendations. Resuscitation 95:e171–e203Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Fabrizio Sandri
    • 1
  • Gina Ancora
    • 2
  • Gianluca Lista
    • 3
  • Luc J. I. Zimmermann
    • 4
  1. 1.Neonatology and Neonatal Intensive Care UnitOspedale MaggioreBolognaItaly
  2. 2.Neonatology and Neonatal Intensive Care UnitOspedale InfermiRiminiItaly
  3. 3.Neonatology and Neonatal Intensive Care UnitOspedale dei Bambini V. BuzziMilanItaly
  4. 4.Department of Pediatrics and NeonatologySchool for Oncology and Developmental Biology (GROW), Maastricht University Medical CenterMaastrichtThe Netherlands

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