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Published on: December 22, 2023

Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm

J J Ho1, D J Henderson-Smart, P G Davis

  • 1Dept Paediatrics, Perak College of Medicine, Greentown, Ipoh, Malaysia, 30450. jho@pc.jaring.my

The Cochrane Database of Systematic Reviews
|June 22, 2002
PubMed

Insights

Early continuous distending pressure (CDP) significantly reduces the need for intermittent positive pressure ventilation in preterm infants with respiratory distress syndrome (RDS). However, further research is needed to re-evaluate its use with modern treatments.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Critical Care

Background:

  • Continuous distending pressure (CDP) shows potential benefits for preterm infants with respiratory distress syndrome (RDS).
  • Early CDP application may reduce lung damage and conserve surfactant, potentially improving outcomes compared to later treatment.
  • Atelectasis can influence the effectiveness of CDP in managing RDS.

Purpose of the Study:

  • To determine if early versus delayed initiation of CDP in preterm infants with RDS lowers mortality.
  • To assess if early CDP reduces the need for intermittent positive pressure ventilation (IPPV).

Main Methods:

  • Systematic review using the Cochrane Neonatal Review Group's standard search strategy.
  • Included randomized or quasi-random trials of preterm infants with RDS who were spontaneously breathing at entry.
  • Data extraction and quality assessment were performed independently by two authors.

Main Results:

  • Early CDP significantly reduced the subsequent use of intermittent positive pressure ventilation (IPPV) (RR 0.55, NNT 6).
  • No significant effect was observed on overall mortality, pneumothorax, or bronchopulmonary dysplasia rates.
  • One study indicated a reduced duration of oxygen therapy with early CDP.

Conclusions:

  • Early CDP application offers clinical benefits by decreasing the need for IPPV in RDS treatment.
  • This reduction may help prevent adverse effects associated with IPPV.
  • Re-evaluation of early CDP is recommended, considering current practices like antenatal steroids and early surfactant administration.
Abstract

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