Strategies in PPROM in Preterm Infants

There is usually pulmonary hypoplasia with relatively normal compliance.
Strategy: Use low PEEP, as high PEEP can interfere with venous return, and cardiac output.

There is usually pulmonary vasoconstriction, and hypertension.
Strategy: Keep PaO2 above 50mm Hg.
Frequent Echocardiograms to evaluate shunting across PDA.
Use iNO as needed.

Ventricular dysfunction, and or systemic hypotension.
Strategy: May use volume and or inotropics (dobutamine if LV dysfunction, and dopamine if systemic hypotension)
Use inotropes if there is LV systolic dysfunction with or without left atrial dialatation before using iNO to avoid pulmonary edema.
Source: Journal of Pediatrics, 2015, Dr. de Waal, and Dr. Kluckow.