Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences

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Published on: November 20, 2015

Peter A Dargaville1, Ajit Aiyappan, Antonio G De Paoli

  • 1Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Tas., Australia. peter.dargaville@dhhs.tas.gov.au

Neonatology
|April 19, 2013
PubMed

Insights

Continuous positive airway pressure (CPAP) failure in preterm infants is common, especially in those with respiratory distress syndrome. High initial oxygen needs predict CPAP failure, leading to worse outcomes.

Area of Science:

  • Neonatal Medicine
  • Respiratory Support

Background:

  • Continuous positive airway pressure (CPAP) is increasingly used for preterm infants (≤32 weeks' gestation) without prior intubation or surfactant.
  • Some infants managed with CPAP require intubation and ventilation due to treatment failure.

Purpose of the Study:

  • To determine the incidence, predictors, and consequences of CPAP failure in preterm infants.
  • To identify factors associated with CPAP failure and compare outcomes between successful and failed CPAP groups.

Main Methods:

  • Infants (25-32 weeks' gestation) received CPAP as initial respiratory support.
  • Infants were grouped into CPAP success (CPAP-S) or CPAP failure (CPAP-F, requiring intubation <72 hours).
  • Predictors of CPAP failure and outcomes were analyzed.

Main Results:

  • CPAP failure occurred in 22% (65/297) of infants, with higher incidence at lower gestational ages.
  • Highest initial FiO₂ predicted CPAP failure. Infants with CPAP failure had prolonged respiratory support needs.
  • CPAP failure was linked to increased risk of death or bronchopulmonary dysplasia (25-28 weeks) and pneumothorax (29-32 weeks).

Conclusions:

  • CPAP failure in preterm infants is often due to severe respiratory distress syndrome.
  • An initial FiO₂ ≥0.3 is a predictor of CPAP failure.
  • CPAP failure is associated with significant adverse outcomes, including increased mortality and morbidity.
Abstract

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