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Nighttime view of Temple University Children's Medical Center Temple University Hospital in background, Kresge Hall (left) and Medical Research Building (right) in foreground Old Medical School building in foreground, Jones Hall, General Services building and Student Faculty Center to the right

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Gentle therapies ease breathing for preemies

Nancy Robinson, MD, demonstrates how to fit a chest splint, designed to aid breathing in premature babies, on a model.

Photo:  Nancy Robinson, MD, demonstrates how to fit a chest splint, designed to aid breathing in premature babies, on a model.

 

Once you’ve watched a preemie struggle for air, you’ll never take breathing for granted again. Born with underdeveloped lungs and respiratory systems, the relatively stiff lungs and weak muscles of a premature infant require incredible energy to breathe. The traditional treatment, invasive mechanical ventilation, often used to push air into the babies’ immature lungs, can further stress already compromised breathing passages.


But gentle new treatments developed by researchers at Temple University School of Medicine that are currently under investigation might someday ease their struggle.


“The primary problem with preemies is that things are not ready,” Marla Wolfson, PhD, Associate Professor of Physiology and Pediatrics, explained. “Their bodies are asked to do tasks that their systems can’t handle.”


Marla Wolfson, PhDTo improve the survival rates and decrease complications in these early arrivals, Wolfson and her colleague, Thomas Shaffer, PhD, Professor Emeritus of Physiology and Pediatrics, have developed and studied two novel therapies: a tiny chest splint that stabilizes the ribcage and helps babies to breathe, and a procedure called “liquid ventilation” that replaces air with an inert fluid to reduce stress and prevent the collapse of stiffened lungs. These therapies hold great potential to reduce and potentially eliminate the need for invasive mechanical ventilation, which can be extremely stressful for preemies’ fragile bodies, chest walls and lungs.


According to a recent Institute of Medicine report, premature births make up 12.5 percent of all births in the United States, an increase of 30 percent since 1981. The more premature a baby, the higher the risk of neurodevelopmental handicaps, according to Wolfson’s research partner, Nancy Robinson, MD, Associate Professor of Pediatrics and Director of the Infant Intensive Care Unit at Temple University Children’s Medical Center.


Liquid ventilation replaces air with a fluid that prepares and protects preemies’ underdeveloped lungs from too much pressure and possible collapse. Gas is replaced with perflurochemical liquid, an inert fluid that has a high solubility of oxygen and carbon dioxide and that also shields the delicate tissue against inflammation. Doctors can also control both the pressure and volume of fluid in the lungs, which cushions them against possible over-inflation and collapse. In addition, drugs can be delivered via the fluid.


“The goal is to take a lung that is developmentally unready and to keep it stable so that it has the chance to develop normally,” Wolfson said. “With less stress on the lungs and breathing, babies can stabilize so their lungs can mature.”


Wolfson and Shaffer, who conducted the seminal basic science experiments and first clinical trials of liquid ventilation for premature babies, have received federal and private funding for their research. The therapy continues to be examined in pre-clinical studies; however, the ability to resume clinical trials awaits supplemental funding.


At present, Temple University School of Medicine and Children’s Medical Center is one of four sites nationwide studying the efficacy of chest splints for premature babies. The splint, a snap-together frame of clear plastic, is designed to encircle an infant’s weak chest, stabilizing the rib cage to permit the underdeveloped lungs and chest muscles to draw air more efficiently. In the nursery, its impact is immediate and dramatic: preemies that had been fighting to pull in air, their chests straining with effort, appear more comfortable, their breathing steady and calm.


Wolfson sees great hope in both therapies.


“The chest splint is the first completely non-invasive treatment that works outside the body, while the fluid works from the inside. Both are very gentle and protective,” she said.

 

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- By Ilene Raymond

September 21, 2006