Randomized controlled trial of very early continuous distending pressure in the management of preterm infants

doi:10.1016/0378-3782(87)90097-1

Early Human Development

Volume 15, Issue 1, January 1987, Pages 21-32

https://doi.org/10.1016/0378-3782(87)90097-1 Get rights and content

Abstract

Application of continuous distending pressure at birth (very early CDP) should stabilize the immature airways and reduce the severity of respiratory distress syndrome (RDS) in preterm infants. Eighty-two preterm infants of less than 32 weeks gestation were randomly assigned at birth to early treatment group (TG), in which CDP of 6 cm water pressure was applied at birth by the nasopharyngeal route (NP-CDP), or to control group (CG), in which CDP was applied when indicated for established criteria (pO₂ < 50 mmHg in FiO₂ > 0.5). Characteristics of the infants in the two groups were comparable.

No statistically significant difference between the two groups was found in the incidence of RDS. The course of RDS, and oxygen and ventilatory requirements also did not appear to be changed. In blood gas parameters of most of the time frames, no significant difference was found between the two groups when the results were analyzed according to the assigned group. When the results were analyzed separately for the infants who developed RDS, infants in TG appear to have fared worse from the therapy in terms of oxygenation, as indicated by significantly higher FiO₂ (P < 0.01) and lower a/A (P < 0.01) values on the third day of the course of RDS, as compared to infants in CG. The incidence of complications was comparable in the two groups. Four infants from TG (9.3%) and one from CG (2.6%) died (P = NS). We conclude that VECDP by nasopharyngeal route does not reduce the incidence of RDS and does not appear to improve the outcome and may worsen the severity of RDS when compared to application of CDP for established criteria

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To determine whether very low birth weight infants (VLBWIs), initially supported with continuous positive airway pressure (CPAP) and then selectively treated with the INSURE (intubation, surfactant, and extubation to CPAP; CPAP/INSURE) protocol, need less mechanical ventilation than those supported with supplemental oxygen, surfactant, and mechanical ventilation if required (Oxygen/mechanical ventilation [MV]).
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CPAP and early selective INSURE reduced the need for mechanical ventilation and surfactant in VLBWIs without increasing morbidity and death. These results may be particularly relevant for resource-limited regions.
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Therefore, reserving nCPAP for those babies with respiratory difficulties post-extubation may deliver the best results if resources are limited. Two randomised trials25,26 have addressed the question of whether nCPAP commenced soon after birth, irrespective of respiratory status, reduced mortality and morbidity of very preterm infants. The control group in both trials received oxygen via a headbox and additional support (nCPAP or endotracheal tube) if predefined oxygenation criteria were met.
Non-invasive techniques of respiratory support were developed in order to reduce the adverse effects associated with ventilation via an endotracheal tube. Short bi-nasal prongs provide the most effective nasal interface for delivery of nasal continuous positive airway pressure (nCPAP). Devices used to generate CPAP include conventional ventilators, the ‘bubbly bottle’ system and the infant flow driver. NCPAP improves the rate of successful extubation. It is useful for preterm infants with respiratory distress syndrome, reducing time spent on an endotracheal tube and oxygen requirement at 28 d. However, nCPAP is associated with an increased rate of pneumothorax. Nasal intermittent positive pressure ventilation (NIPPV) is useful for augmenting the effectiveness of nCPAP. It further improves rates of successful extubation and shows promise as an initial method of respiratory support. Further research is required to determine the optimal settings for both nCPAP and NIPPV.
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Randomized controlled trial of very early continuous distending pressure in the management of preterm infants

Abstract

J. Pediatr.

J. Pediatr.

J. Pediatr.

Immediate intubation at birth of the very low birth weight infant

Am. J. Dis. Childh.