Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP

Abstract

In this paper, a retrospective study was performed to find out whether the introduction of early nasal continuous positive airway pressure (nCPAP) as a new standard regime of very low birthweight infants will lead to a decreasing tracheal intubation and ventilation rate, as well as to a lower incidence of bronchopulmonary dysplasia in a tertiary-level perinatal centre. Ninety-three infants (study group) with early nCPAP as the first respiratory support were compared to 63 infants (historical control group) born before the use of early nCPAP. No statistically significant differences were found in the baseline characteristics. The main results of the study include reduced intubation mainly in infants with a birthweight <1,000 g (study group): 58% vs. 81% (p < 0.05). The mean duration of ventilation was 248 h (control group) vs. 128 h (study group) (p < 0.001) and 437 h vs. 198 h in infants <1,000 g (p < 0.001). There was significantly reduced incidence of bronchopulmonary dysplasia from 55% to 18% for all surviving infants (p < 0.001), and for infants <1,000 g, it was 90% vs. 30% (p < 0.001). No significant differences for other outcome criteria were noted, but a significant reduction in the use of central i.v. lines, fluids, drugs, volume expansion, sedation, catecholamines, surfactant, steroids and buffer, as well as antibiotics, was observed (p < 0.05). Therefore, we can conclude that early nCPAP is an easy-to-use and safe procedure for very low birthweight infants to treat respiratory distress.

Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

“…Compared to non-EnCPAP neonates, EnCPAP neonates had reduced mortality, mechanical ventilation, BPD and PH, without an increased risk of pneumothorax. The lower rates of endotracheal intubation at birth and surfactant therapy despite more RDS in our EnCPAP neonates were similar to those reported by others [13,14,15,16,17,18,19,20,21]. Contrary to studies reported elsewhere, our EnCPAP neonates had a significantly lower mortality at discharge [3,4,22] and no increased risk of IVH [22].…”

Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

“…nasal and tracheal continuous positive airway pressure; vagotomy; laryngotracheal separation; bronchopulmonary receptors NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) has been used in newborns for a number of years for treating respiratory distress syndrome and apneas of prematurity and as a bridge between endotracheal tube ventilation and spontaneous ventilation (4,6,10). However, laryngeal functions, such as nonnutritive swallowing (NNS), which fulfils the important task of clearing upper airways from secretions and liquids refluxed from the stomach, have not been specifically assessed in newborns during nasal CPAP, aside from one study wherein nasal CPAP was shown to increase laryngeal opening (5).…”

Early versus delayed initiation of nasal continuous positive airway pressure for treatment of respiratory distress syndrome in premature newborns: A randomized clinical trial

“…At histological examination, surfactant-deficient lungs have areas of atelectasis and overinflation, which could be effectively prevented by application of n CPAP shortly after birth. [8910] Therefore, early application of n CPAP may be effective in the management of RDS. Previous descriptions have been described in trials in which “early” CPAP was started at a variable period of time extending several hours after birth.…”

“…They found that in infants with birth weight less than 1000 g, the use of early n CPAP significantly reduced intubation rate, duration of ventilation and incidence of bronchopulmonary dysplasia. [10]…”

“…Therefore, we found that the early use of n CPAP could be cost-effective in the treatment of RDS, which is comparable to the study of Miksch et al . [10]…”