Continuous distending pressure for respiratory distress syndrome in preterm infants

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Published on: December 22, 2023

J J Ho1, P Subramaniam, D J Henderson-Smart

  • 1Paediatrics, Perak College of Medicine, Jalan Greeentown, Ipoh, MALAYSIA, 30450. jackie@perakmed.edu.my

The Cochrane Database of Systematic Reviews
|October 18, 2000
PubMed

Insights

Continuous distending pressure (CDP) reduces respiratory failure and mortality in preterm infants with respiratory distress syndrome (RDS). However, CDP use is linked to an increased risk of pneumothorax, necessitating further research for modern applications.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Respiratory distress syndrome (RDS) is a primary cause of illness and death in preterm infants.
  • Intermittent positive pressure ventilation (IPPV) is standard but invasive, causing lung injury and chronic lung disease.
  • Continuous distending pressure (CDP) offers a less invasive alternative.

Purpose of the Study:

  • To evaluate if continuous distending pressure (CDP) reduces the need for IPPV in spontaneously breathing preterm infants with RDS.
  • To assess associated morbidities and adverse effects of CDP compared to standard care.

Main Methods:

  • Systematic review of randomized and quasi-random trials of CDP (CPAP or CNP) versus standard care in newborn infants with RDS.
  • Searches included major databases (MEDLINE, Cochrane Trials) and expert consultations.
  • Data were independently assessed for quality and extracted by authors.

Main Results:

  • CDP use was associated with lower rates of treatment failure (death or need for ventilation) and overall mortality.
  • Infants weighing over 1500g showed reduced mortality with CDP.
  • An increased incidence of pneumothorax was observed with CDP application.

Conclusions:

  • CDP (CPAP or CNP) offers benefits in reducing respiratory failure and mortality in preterm infants with RDS.
  • A significant increase in pneumothorax risk is associated with CDP.
  • The applicability of findings from the 1970s is limited due to outdated methods and lack of modern interventions (surfactant, antenatal corticosteroids).
  • CPAP may be valuable in resource-limited settings; further research is needed for current intensive care practices.
Abstract

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