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July 6, 2021

Evolving Respiratory Care of the Preterm Infant

Author Affiliations
  • 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2021;175(10):1004-1005. doi:10.1001/jamapediatrics.2021.1918

In 1963, the death of President John F. Kennedy and First Lady Jacqueline Kennedy’s son from respiratory failure secondary to hyaline membrane disease drew international attention to the potentially devastating consequences of premature birth and the burgeoning field of neonatology.1 Since that time, multiple pharmacologic and respiratory support strategies have been subjected to rigorous testing in randomized clinical trials and the respiratory care of preterm infants has undergone nearly continuous evolution. These advances, together with simultaneous improvements in obstetric and nonrespiratory aspects of neonatal care, have contributed to a steady decrease in the gestational age at which preterm infants can survive.2 Today, the care of infants like Patrick Kennedy, who was born at 34 weeks’ gestation, is considered routine and survival is nearly 100%. However, there is now uncertainty about the optimal care of infants born extremely preterm, where survival is possible, but both acute and chronic respiratory failure are common morbidities. In an effort to foster continued improvements in the outcomes of premature infants, it is necessary to periodically assess how respiratory care practices in this population are evolving and ascertain whether these changes are accompanied by reductions in morbidity and mortality. Such data are key for understanding how research influences clinical care and to benchmark the current state of respiratory care practices for future improvement efforts.

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