Sustainable use of continuous positive airway pressure during the first week after delivery in extremely preterm infants

Claire Booth ¹, Murali H Premkumar ², Angela Yannoulis ², Merran Thomson ², Mike Harrison ² and A D Edwards ^2*

¹ Division of Clinical Sciences, Imperial College London, United Kingdom
² Neonatal Unit, Queen Charlottes and Chelsea Hosptial, Hammersmith Hospital, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: david.edwards{at}imperial.ac.uk.

Accepted 22 June 2006

Abstract

Background: Early use of nasal continuous positive airway pressure (nCPAP) may reduce lung damage but it is not clear how many extremely preterm infants can be cared for without mechanical ventilation on the first days after delivery.

Objectives: To describe our experience of n CPAP of infants born at less than 27 weeks gestation and determine the chance of reintubation of this group of extremely preterm infants.

Methods: A retrospective, observational study examined the period November 2002 to October 2003, when efforts were made to extubate infants at the earliest opportunity to nCPAP. Data was collected on all infants admitted to our unit born at <27 weeks gestation. We estimated the chance of an individual infant requiring reintubation within 48 hours of delivery, calculating the predictive probability using a Bayesian approach, and examined oxygen requirements at 36 weeks corrected gestational age.

Results: 60 infants, 34 inborn and 26 ex-utero transfers were admitted; 7 admitted after 24 hours of age were excluded and 5 infants died within 48 hours. The mean birth weight was 788g and gestational age was 25+2 weeks. Extubation was attempted on day 1 in 21/52 ventilated infants and was successful in 14; and on day 2 in 14/35 and successful in 10. 85% of infants extubated within 48 hours of delivery survived to discharge. 5 out of 23 infants on mechanical ventilation at 48 hours of age were in air at 36 weeks CGA and 12/26 of those on nCPAP at 48 hours of age. The predictive probability of an individual baby remaining on nCPAP was 66% (CI 46-86%) on day one and 80% (60-99%) on day two. The smallest infant to be successfully extubated was 660g and the youngest gestational age 23+6 weeks.

Conclusions: Extremely preterm can be extubated to nCPAP soon after delivery with a reasonable probability of not requiring immediate reintubation.

Keywords: CPAP, preterm

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