Endotracheal continuous positive airway pressure after rescue surfactant therapy.
OBJECTIVE
To determine if premature infants greater than 31 weeks of gestation with established hyaline membrane disease (HMD) can be treated with endotracheal continuous positive airway pressure (ETCPAP) after rescue surfactant replacement therapy.


METHODS
Retrospective study of 46 premature infants (>31 weeks of gestation) admitted to Texas Children's Hospital with HMD. Tolerance to ETCPAP after surfactant replacement was evaluated. Prenatal and postnatal characteristics and outcome were compared in the success and failure groups. Multiple logistic regression was used to determine predictive factors associated with failure.


RESULTS
Thirty infants (65.2%) were successfully treated with rescue surfactant and ETCPAP. Cesarean section, higher 1-minute Apgar score, and higher FiO2 level at entry were independent predictors of failure to remain on CPAP due to hypoxemia (56.3%), hypercapnia (31.2%), and apnea (12.5%). In the success group duration of intubation (p < 0.001), oxygen administration (p < 0.01), >40% oxygen requirement (p < 0.001), hospital stay (p < 0.05), and respiratory support on day 7 (p < 0.001) were significantly favorable.


CONCLUSIONS
Two thirds of infants greater than 31 weeks of gestation, with HMD needing rescue surfactant treatment, can be successfully managed with ETCPAP.
Mandy
G T
GT
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Moïse
A A
AA
Smith
E O
EO
Hansen
T N
TN
D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D005865:Gestational Age; D006801:Humans; D006819:Hyaline Membrane Disease / Q000628:therapy*; D007231:Infant, Newborn; D011175:Positive-Pressure Respiration; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D011663:Pulmonary Surfactants