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Sustained lung inflation, CPAP decreased need for mechanical ventilation
Results from a randomized controlled study indicated that administering sustained lung inflation and positive end-expiratory pressure in the delivery room decreased the need for mechanical ventilation in the first 72 hours of life among preterm infants at high risk for respiratory distress syndrome.
“Although the respiratory support of preterm infants with respiratory distress syndrome has improved and new modes of mechanical ventilation have been developed, the incidence of [bronchopulmonary dysplasia] has remained high,” study researcher Gianluca Lista, MD, of Vittore Buzzi Children’s Hospital in Milan, Italy, and colleagues wrote. “An aspect of respiratory care of preterm infants that has not yet been thoroughly investigated is the support given in the delivery room immediately after birth.”
Researchers randomly assigned 294 infants considered at high risk for respiratory distress syndrome to receive sustained lung inflation followed by continuous positive airway pressure (CPAP) or CPAP only immediately after birth. Study participants were born at 25 weeks to 29 weeks gestation.
Compared with infants who received sustained lung inflation plus CPAP (53%), infants who received CPAP only (65%) had an unadjusted OR of 0.62 (95% CI, 0.38-0.99) for mechanical ventilation within the first 72 hours of life.
Thirty-five percent of infants who received CPAP only had bronchopulmonary dysplasia at 36 weeks gestation, compared with 39% of infants who received sustained lung inflation plus CPAP.
The overall rate for bronchopulmonary dysplasia was 35% among infants who received CPAP only vs. 38.5% among infants who received sustained lung inflation plus CPAP.
Infants who received sustained lung inflation plus CPAP had a slightly higher rate for mortality before postmenstrual age of 36 weeks compared with infants who received CPAP only (15.4% vs. 12.8%).
“Our study found that [sustained lung inflation] followed by early CPAP in the delivery room decreased the need for [mechanical ventilation] in the first 72 hours of life in extremely preterm infants compared with CPAP alone but did not decrease the need for respiratory support and the occurrence of [bronchopulmonary dysplasia],” Lista and colleagues wrote. “We believe that other clinical studies are necessary to investigate the effectiveness of [sustained lung inflation] in improving outcomes in extremely preterm infants.” – by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.
