Continuous Positive Airway Pressure versus Mechanical Ventilation on the First Day of Life in Very Low-Birth-Weight Infants

Abstract

Objective The objective of this study was to determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in very low-birth-weight (VLBW) infants managed successfully on continuous positive airway pressure (CPAP) versus mechanical ventilation on the first day of life (DOL). Study Design This is a retrospective analysis of the Alere neonatal database for infants born between January 2009 and December 2014, weighing ≤ 1,500 g. Baseline demographics, clinical characteristics, and outcomes were compared between the two groups. Multivariate regression analysis was performed to control the variables that differ in bivariate analysis. Results In this study, 4,629 infants (birth weight 1,034 ± 290 g, gestational age 28.1 ± 2.5 weeks) met the inclusion criteria. The successful use of early CPAP was associated with a significant reduction in BPD or death (p < 0.001), as well as days to room air, decreased oxygen use at discharge, lower risk for severe intraventricular hemorrhage, and patent ductus arteriosus requiring surgical ligation (p < 0.001 for all outcomes). Conclusion Successful use of early CPAP on the first DOL in VLBW infants is associated with a reduced risk of BPD or death.

Evaluation of Trends in Bronchopulmonary Dysplasia and Respiratory Support Practice for Very Low Birth Weight Infants: A Population-Based Cohort Study

“…Primary CPAP therapy reduced the risk of BPD and death compared with mechanical ventilation. 24 Adverse antenatal factors, such as chorioamnionitis, preeclampsia, preexisting hypertensive disorders, gestational diabetes, and maternal obesity, have been strongly associated with an increased risk of BPD. [25][26][27] A meta-analysis found that chorioamnionitis exposure is significantly associated with BPD (OR, 1.29).…”

High-Resolution Computed Tomography Scores in Cases of Bronchopulmonary Dysplasia

“…The average duration of total oxygen support of our cases was calculated as 50 ± 16:7 days; it has been determined that there are a lot of oxygen supply periods exceeding the classical identification criterion for the oxygenation time of 28 days and more too much. In preterm infants with moderate and severe BPD, the duration of mechanical ventilation or the duration of CPAP was found longer and there is an idea that the pro-longation of respiratory support will increase the barotrauma and will aggravate the BPD or that severe BPD will require longer ventilation [16][17][18][19][20]. Long-term cardiac and respiratory prognosis of newborns with BPD is still unknown.…”

Changes in respiratory management and the impact on bronchopulmonary dysplasia

“…[1][2][3][4][5] A shift in respiratory management using more noninvasive respiratory support immediately after birth (without surfactant instillation) is associated with a reduction in mechanical ventilation. [6][7][8] However, the advantages of this practice on long-term respiratory outcome has been questioned. 9 Therefore, further investigation is urgently needed to determine the best respiratory care practices for very premature neonates.…”