Non-invasive open lung strategy in delivery room: randomized controlled trial (OpenCPAP-DR).

Area of Science:

• Neonatal respiratory support
• Pediatric critical care
• Pulmonary physiology

Background:

• No established evidence-based PEEP level for early nCPAP in very preterm infants.
• Increasing pressure over oxygen is preferred for nCPAP stabilization in the delivery room when targets aren't met.

Purpose of the Study:

• To compare individualized nCPAP with different PEEP levels.
• To assess effects on heart rate, SpO2, and surfactant needs in very preterm infants.
• To evaluate SpO2/FiO2 ratio and Oxygen Saturation Index (OSI) at 5 and 10 minutes.

Main Methods:

• Multicenter randomized controlled trial in delivery rooms and NICUs.
• Infants <31 weeks gestation randomized to standard (6 cmH2O) or open CPAP (8 cmH2O).
• Pressure escalated if targets not met; FiO2 titrated; NIPPV/surfactant used if FiO2 >40%.

Main Results:

• Higher PEEP escalation needed in the standard CPAP group.
• No difference in SpO2/FiO2 ratio at 5 or 10 minutes.
• Higher OSI in the open CPAP group due to increased pressure.

Conclusions:

• Initiating nCPAP at 6 cmH2O frequently requires escalation for very preterm infants.
• Higher initial PEEP may aid lung recruitment in the delivery room.
• Further investigation of individualized, higher initial PEEP is warranted.