Long-term outcome of preterm infants treated with nasal continuous positive airway pressure

Abstract

This study's aim was to assess neurodevelopmental and growth outcome until the age of 4 years of premature infants placed on early nCPAP, in the setting of the neonatal intensive care unit (NICU) and follow-up program of the Division of Neonatology of the Department of Pediatrics of the University Hospital, Lausanne, Switzerland. All consecutive inborn infants weighing <1500 g or <32 weeks of gestational age admitted to the NICU during two periods of 12 months-7.1996-6.1997 and 7.1998-6.1999-were compared before and after the systematic application of early nCPAP. Of 172 infants admitted to the NICU, 150 (87%) survived. 126 (84%) were tested at 6 months' corrected age, 121 (81%) at 18 months' corrected age, and 117 (78%) at the age of 4 years. Detailed perinatal data were collected. Follow-up included neurological examination, developmental testing and measurement of growth parameters. Statistical analyses were performed. Early application of nCPAP and avoidance of mechanical ventilation showed no adverse effects on neurodevelopment and growth. A significantly higher developmental quotient was found in the nCPAP group at 18 months' corrected age. Several trends were also noted in the nCPAP group with a decrease of intraventricular hemorrhage and in "abnormal neurodevelopment" at 6 months corrected age, a bigger head circumference at all different tested ages and a greater height at 6 and 18 months corrected ages. In conclusion, our study of developmental outcome documents the absence of any harmful effect of early application of nCPAP to treat respiratory failure in very low birthweight infants.

A Randomized, Controlled Trial of Delivery-Room Respiratory Management in Very Preterm Infants

“…This attempt to avoid intubation and mechanical ventilation may reduce lung injury and BPD in preterm infants as suggested in a retrospective study by Lindner et al 10 A trial of ENCPAP at birth seems justified in infants at risk of respiratory distress syndrome (RDS), providing early surfactant rescue is given if required. 11,12 We performed a randomized, controlled trial and compared the traditional ventilatory approach with a new method that combined a number of techniques, which theoretically could improve the respiratory outcome of preterm infants. We hypothesized that a sustained inflation followed by ENCPAP, using a pressure-limited mechanical device, is a more effective and less injurious management strategy in preterm infants than conventional intervention.…”

Neurodevelopmental outcomes of preterm infants

“…caffeine [51]), unchanged (e.g. methods of ventilation, positive airway pressure or lucinactant surfactant [52][53][54][55]) or higher (e.g. some adverse effects with inhaled nitric oxide [56,57]).…”

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] To avoid collinearity with GA, BW was converted to BW z-score. 28 The adjusted risk difference (RD) and number needed to treat (NNT) were obtained from the adjusted RR and the proportion of DR intubation before SUPPORT.…”