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A randomized, controlled trial of delivery-room respiratory management in very preterm infants
Arjan B te Pas1, Frans J Walther
1Department of Pediatrics, Leiden University Medical Center, J6-S, Box 9600, 2300 RC Leiden, The Netherlands. a.b.te_pas@lumc.nl
Insights
A new ventilation strategy using sustained inflation followed by early nasal continuous positive airway pressure significantly reduced bronchopulmonary dysplasia in very preterm infants compared to conventional methods.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Initial ventilation strategies impact bronchopulmonary dysplasia development in very preterm infants.
- Early nasal continuous positive airway pressure is common, but lacks robust clinical trial data.
- The study investigated a novel approach involving sustained inflation preceding nasal continuous positive airway pressure.
Purpose of the Study:
- To evaluate the efficacy and safety of a sustained inflation followed by early nasal continuous positive airway pressure (nCPAP) strategy.
- To compare this novel approach against conventional ventilation methods in very preterm infants.
- To reduce the incidence of bronchopulmonary dysplasia and need for mechanical ventilation.
Main Methods:
- A randomized clinical trial involving 207 very preterm infants.
- Intervention group received sustained inflation via nasopharyngeal tube followed by early nCPAP (early functional residual capacity intervention).
- Control group received repeated manual inflations with a bag-mask followed by nCPAP if needed.
Main Results:
- Fewer infants in the early functional residual capacity intervention group required intubation before 72 hours of age.
- The intervention group received fewer doses of surfactant and had shorter durations of ventilatory support.
- Bronchopulmonary dysplasia occurred less frequently in infants receiving the sustained inflation and early nCPAP strategy.
Conclusions:
- Sustained inflation followed by early nasal continuous positive airway pressure is a more effective strategy for very preterm infants.
- This method proves more efficient than conventional bag-mask ventilation and delayed nCPAP.
- The findings support the early functional residual capacity intervention as a beneficial approach in neonatal respiratory care.
Background:
Initial ventilation strategy may play an important role in the development of bronchopulmonary dysplasia in very preterm infants. Early nasal continuous positive airway pressure is an accepted approach, but randomized clinical trials are lacking. Our aim was to determine whether early nasal continuous positive airway pressure, preceded by a sustained inflation, is more effective and less injurious in very preterm infants than conventional intervention.
Methods:
Two hundred seven very preterm infants were assigned randomly in the delivery room to either a sustained inflation through a nasopharyngeal tube followed by early nasal continuous positive airway pressure (early functional residual capacity intervention) or repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure, if necessary, after arrival at the NICU. The primary outcome measure was intubation <72 hours of age and bronchopulmonary dysplasia at 36 weeks was used as secondary outcome. This trial was registered as an early functional residual capacity intervention trial (ISRCTN 12757724).
Results:
In the early functional residual capacity intervention group, fewer infants were intubated at <72 hours of age or received >1 dose of surfactant, and the average duration of ventilatory support was less. Infants in the early functional residual capacity intervention group developed bronchopulmonary dysplasia less frequently.
Conclusions:
A sustained inflation followed by early nasal continuous positive airway pressure, delivered through a nasopharyngeal tube, is a more efficient strategy than repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure on admission to the NICU.
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