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[Prophylactic CPAP versus therapeutic CPAP in preterm newborns of 28-32 gestational weeks]
Gabriela Zaharie1, Daniela Adriana Ion, Nadia Schmidt
1Catedra de Neonatologie, UMF ,Iuliu Haţieganu din Cluj-Napoca. gabriela_zaharie@yahoo.com
Insights
Early use of Continuous Positive Airway Pressure (CPAP) in preterm infants may reduce the need for mechanical ventilation and surfactant. This non-invasive method shows benefits in treating respiratory arrest in newborns, potentially lowering complications like PDA.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care Pediatrics
Background:
- Strategies minimizing lung injury in extremely low birth weight newborns improve prognosis.
- Continuous Positive Airway Pressure (CPAP) is used for infant respiratory arrest, with varying approaches to its application.
- Avoiding endotracheal intubation preserves mucociliary flow and reduces mucosal injury and infection risk.
Purpose of the Study:
- To compare the need for mechanical ventilation and surfactant administration.
- To evaluate complications and hospitalization duration in VLBW and ELBW infants.
- To assess outcomes between prophylactic and curative CPAP application.
Main Methods:
- A prospective study of 90 newborns not intubated at delivery and without major malformations.
- Preventive CPAP applied within 30 minutes of birth; therapeutic CPAP for infants needing >40% oxygen.
- Comparison of outcomes between a curative CPAP group (A, n=25) and a preventive CPAP group (B, n=65).
Main Results:
- Surfactant was needed in 40% of group A vs. 23% of group B (p=0.269).
- Mechanical ventilation was required in 72% of group A vs. 53.84% of group B within 72 hours.
- Patent Ductus Arteriosus (PDA) occurred in 38% of group A vs. 7.69% of group B (p=0.001).
Conclusions:
- Continuous Positive Airway Pressure (CPAP) is a beneficial non-invasive method for preterm newborns (28-32 weeks gestation) with respiratory arrest.
- Early CPAP application may decrease the requirement for surfactant and mechanical ventilation.
- Prophylactic CPAP may reduce the incidence of Patent Ductus Arteriosus (PDA) in VLBW/ELBW infants.
Unlabelled:
Strategies in ventilation and in exposure to the oxygen that minimise lung injury improved the prognosis of the extremely low weight newborns. Avoiding intubation can prevent the reduction of mucociliary flow, injury of the mucosa and infection. Using early CPAP isn't unanimous; there are differences between studies in what are concerned: the beginning of the treatment, gestational age, methods. CPAP is used in the treatment of respiratory arrest of infants since 1971, initially endotracheal, than with different nasal instruments. The studies evaluate the benefits of prophylactic or curative CPAP.
Objectives:
To compare the necessity for mechanical ventilation and surfactant administration, complications and the period of hospitalisation in VLBW and ELBW, that were under prophylactic or curative CPAP.
Material And Method:
We made a prospective study on 90 newborns, during january 2004 and june 2006, that were not intubated in the delivery room with no major malformations. Preventive CPAP was applied in the first half an hour after birth. therapeutical CPAP was applied only in infants with the necessity in oxygen over 40%, to maintain the saturation between 90 - 95%. Group A (curative CPAP) - 25 cases, the average for gestational age 30,30+/-2,45 weeks and for birth weight 1588,00+/-573,05. For group B the averages were: 30,08+/-2,30 weeks and 1508,50+/-400,83 grams.
Results:
Surfactant was necessary in 40% of group A, over 23% in group B (p = 0,269). Mechanical ventilation in first 72 hours of life was necessary in 18 cases (72%) - A and in 35 cases (53,84%) - B. The necessity for CPAP in hours: 92,15+/-3,85 in group A, over 112,25+/-5,75 group B (p = 0,044). Complications we considered: PDA and cerebral hemorrhage. We had 8 cases (38%) of group A with PDA, significantly different of group B: 5 cases (7,69%). Cerebral hemorrhage was absent in 40% of group A and in 73,84% in group B (p = 0,11).
Conclusions:
CPAP is a non invasive method with benefits in the treatment of the respiratory arrest in preterm newborn of 28 - 32 gestational weeks. Using early CPAP may reduce: necessity for surfactant, mechanical ventilation and PDA.
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