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Pulmonary air leak associated with CPAP at term birth resuscitation
  1. Kenji Hishikawa1,
  2. Keiji Goishi1,
  3. Takeo Fujiwara2,
  4. Masao Kaneshige1,
  5. Yushi Ito1,
  6. Haruhiko Sago3
  1. 1Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
  2. 2Department of Developmental Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
  3. 3Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
  1. Correspondence to Dr Kenji Hishikawa, Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo 157-8535, Japan; hishikawa.k1234{at}gmail.com

Abstract

Objective The Japan Resuscitation Council (JRC) Guidelines 2010 for neonatal resuscitation introduced continuous positive airway pressure (CPAP) in delivery room. The present study evaluated the effect of CPAP for pulmonary air leak at term birth.

Design, setting and patients This retrospective single-centre study used the data of term neonates who were born without major congenital anomalies at our centre between 2008 and 2009, and between 2011 and 2012.

Interventions Resuscitation according to the JRC Guidelines 2010.

Main outcome measures We examined the association between the JRC Guidelines 2010, CPAP by face mask and pulmonary air leak.

Results A total of 5038 infants were analysed. The frequency of CPAP by face mask increased after the update of the JRC Guidelines in 2010 (1.7% vs 11.1%; p<0.001). Pulmonary air leak increased at early term (37 weeks: 1.0% vs 3.5%, p=0.02; 38 weeks: 0.7% vs 2.2%, p=0.02). While adjusting for confounders, the JRC Guidelines 2010 was associated with pulmonary air leak in early-term neonates (37 weeks: adjusted OR (aOR) 4.37; 95% CI 1.40 to 17.45; 38 weeks: aOR 2.80; 95% CI 1.04 to 8.91), but this association disappeared while adjusting for face mask CPAP additionally (37 weeks: aOR 1.90; 95% CI 0.47 to 8.71; 38 weeks: aOR 1.66; 95% CI 0.54 to 5.77).

Conclusions Following the update of the JRC guidelines on neonatal resuscitation, we observed an increased use of CPAP via face mask, which was associated with a higher prevalence of pulmonary air leak in early-term neonates in our centre.

  • pulmonary air leak
  • term newborn
  • neonatal pneumothorax
  • neonatal cardiopulmonary resuscitation
  • continuous positive airway pressure

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