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Published on: November 20, 2015
Incidence and Outcome of CPAP Failure in Preterm Infants
Peter A Dargaville1, Angela Gerber2, Stefan Johansson3
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia; peter.dargaville@dhhs.tas.gov.au.
Insights
Continuous positive airway pressure (CPAP) failure in preterm infants significantly increases the risk of death and major morbidities like bronchopulmonary dysplasia (BPD). Strategies to optimize CPAP use are crucial for improving outcomes in neonates.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Clinical Pediatrics
Background:
- Continuous positive airway pressure (CPAP) is a standard initial respiratory support for preterm infants.
- Concerns exist regarding the efficacy and potential failure rates of CPAP in this vulnerable population.
- Understanding CPAP failure incidence and outcomes is vital for refining neonatal respiratory care.
Purpose of the Study:
- To determine the incidence of CPAP failure in preterm infants.
- To explore the association between CPAP failure and neonatal outcomes.
- To analyze outcomes based on gestational age at CPAP initiation.
Main Methods:
- Analysis of Australian and New Zealand Neonatal Network data (2007-2013).
- Inclusion of inborn preterm infants initiated on CPAP (gestational age 25-32 weeks).
- Comparison of outcomes for CPAP failure (intubation <72 hours) versus CPAP success using adjusted odds ratios.
Main Results:
- CPAP failure occurred in 43% of infants at 25-28 weeks and 21% at 29-32 weeks.
- CPAP failure was linked to higher rates of pneumothorax, death, and bronchopulmonary dysplasia (BPD).
- Infants with CPAP failure experienced longer respiratory support and hospitalization durations.
Conclusions:
- CPAP failure in preterm infants is associated with significantly increased mortality and major morbidities, including BPD.
- The study highlights the critical need for strategies to enhance the success of CPAP application in neonates.
- Optimizing CPAP management is essential for improving survival and reducing long-term complications in preterm infants.
Background And Objectives:
Data from clinical trials support the use of continuous positive airway pressure (CPAP) for initial respiratory management in preterm infants, but there is concern regarding the potential failure of CPAP support. We aimed to examine the incidence and explore the outcomes of CPAP failure in Australian and New Zealand Neonatal Network data from 2007 to 2013.
Methods:
Data from inborn preterm infants managed on CPAP from the outset were analyzed in 2 gestational age ranges (25-28 and 29-32 completed weeks). Outcomes after CPAP failure (need for intubation <72 hours) were compared with those succeeding on CPAP using adjusted odds ratios (AORs).
Results:
Within the cohort of 19 103 infants, 11 684 were initially managed on CPAP. Failure of CPAP occurred in 863 (43%) of 1989 infants commencing on CPAP at 25-28 weeks' gestation and 2061 (21%) of 9695 at 29-32 weeks. CPAP failure was associated with a substantially higher rate of pneumothorax, and a heightened risk of death, bronchopulmonary dysplasia (BPD) and other morbidities compared with those managed successfully on CPAP. The incidence of death or BPD was also increased: (25-28 weeks: 39% vs 20%, AOR 2.30, 99% confidence interval 1.71-3.10; 29-32 weeks: 12% vs 3.1%, AOR 3.62 [2.76-4.74]). The CPAP failure group had longer durations of respiratory support and hospitalization.
Conclusions:
CPAP failure in preterm infants is associated with increased risk of mortality and major morbidities, including BPD. Strategies to promote successful CPAP application should be pursued vigorously.
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