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Early CPAP versus surfactant in extremely preterm infants

, Neil N Finer, Waldemar A Carlo

    The New England Journal of Medicine
    |May 18, 2010
    PubMed

    Insights

    Continuous positive airway pressure (CPAP) offers an alternative to early surfactant treatment for extremely-low-birth-weight infants. This approach reduces the need for intubation and mechanical ventilation, supporting preterm infant respiratory care.

    Area of Science:

    • Neonatal Medicine
    • Respiratory Care
    • Pediatric Critical Care

    Background:

    • Limited data exist comparing early continuous positive airway pressure (CPAP) versus early surfactant treatment for extremely-low-birth-weight (ELBW) infants.
    • Choosing initial respiratory support for ELBW infants remains a clinical challenge.

    Purpose of the Study:

    • To compare the efficacy of early CPAP versus early surfactant treatment as initial respiratory support in ELBW infants.
    • To evaluate the impact of these strategies on major neonatal outcomes, including death and bronchopulmonary dysplasia.

    Main Methods:

    • A randomized, multicenter, 2x2 factorial trial involving infants born between 24 and 27 weeks 6 days gestation.
    • Infants were assigned to either intubation and surfactant treatment or CPAP initiated in the delivery room.
    • A secondary randomization involved target oxygen saturation ranges.

    Main Results:

    • The primary outcome (death or bronchopulmonary dysplasia) did not differ significantly between the CPAP and surfactant groups (47.8% vs. 51.0%).
    • CPAP use was associated with significantly less need for intubation, postnatal corticosteroids, and fewer days of mechanical ventilation.
    • Infants receiving CPAP were more likely to be alive and free from mechanical ventilation by day 7.

    Conclusions:

    • CPAP is a viable alternative to intubation and surfactant treatment for preterm infants.
    • Early CPAP initiation may reduce the need for invasive ventilation and associated complications in ELBW infants.
    Abstract

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