Effect of Pulmonary Complications on Neonates with Bronchopulmonary Dysplasia: A Systematic Review Protocol

Introduction

Bronchopulmonary dysplasia is a most commonly seen chronic lung disease in premature infants. Mechanical ventilation and oxygen therapy are required in acute respiratory distress and are mainly seen in neonates with minimal severity in the respiratory course.¹ Neonatal respiratory distress syndrome (NRDS) was introduced in 1967 by Northway et al. The new author categorized this under syndrome with features that described airway histopathology.² Preterm birth occurs before 295 days or before the 37^th week of gestation, which causes 75% perinatal mortality.³ The incidence of bronchopulmonary complications increases as gestational birth age decreases. Higher incidences of preterm infants suffering from respiratory, gastrointestinal, and cognitive issues are seen even after their survival. The global incidence of bronchopulmonary dysplasia is 1-75%. The incidence rate in Asia is 18-85%.⁴ Bronchopulmonary dysplasia is defined as a chronic lung disease that affects or injures the premature lung, which requires mechanical ventilation or oxygen support therapy. It is primarily observed in moderate or late preterm neonates after initial respiratory distress syndrome (ARDS). It is further classified as classic or old.⁵ According to diagnostic criteria, BPD syndrome is diagnosed based on gestational age, assessment point, and severity of the neonates who require oxygen support of more than 21% for more than 28days. It is mostly observed in preterm infants born before 30 weeks or weighing less than 1,500 g. The short-to long-term complications of bronchopulmonary dysplasia include increased susceptibility to pulmonary infections, impaired tolerance to exercise, pulmonary hypertension, increased risk of cerebral palsy and developmental delay, lower IQ, impaired executive function, asthma and COPD.⁶

What impact does pulmonary complications in neonates have on the incidence of primary complications, such as respiratory distress syndrome with bronchopulmonary dysplasia, when compared to standard care? A Systematic Review will be conducted to investigate the efficacy and safety of this intervention, with the aim of improving both short- and long-term outcomes in preterm infants at risk of bronchopulmonary dysplasia.

Methods

The methods of this systematic review were developed and reported in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). In accordance with these guidelines, the study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42024524133.

Discussion

Multimodal stimulation interventions have the potential to positively influence respiratory outcomes in neonates by promoting relaxation, reducing stress responses, and enhancing the respiratory muscle tone. Auditory stimulation, particularly exposure to the mother’s voice, can positively influence respiratory patterns in neonates. Research suggests that soothing sounds such as maternal lullabies or gentle speech can promote relaxation, which may indirectly benefit respiratory function.⁷ Auditory stimulation may help regulate breathing patterns and improve oxygenation in neonates with respiratory issues by fostering a calm environment. Visual stimulation plays a crucial role in the promotion of respiratory stability and development in neonates. Studies have shown that visual interactions, such as making eye contact with caregivers or mothers, can stimulate neural pathways involved in respiratory control.⁸ Vestibular stimulation through rocking movements can have a calming effect on neonates, and may help improve respiratory function. Gentle rocking motion can promote relaxation and reduce respiratory effort, leading to improved oxygenation and ventilation.⁹ Tactile stimulation, such as gentle caressing or skin-to-skin contact, can have profound effects on the respiratory outcomes in neonates. Studies have demonstrated that tactile experience can stimulate the release of endorphins and oxytocin, leading to decreased stress responses and improved respiratory stability.¹⁰ While olfactory and gustatory stimulation may not directly impact respiratory function, they can contribute to a conducive caregiving environment that supports respiratory health.¹¹ Exposure to familiar scents, such as the mother’s odor or breast milk, can promote relaxation and reduce stress levels, which may indirectly benefit respiratory stability.¹²