Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants.
BACKGROUND
This section is under preparation and will be included in the next issue.


OBJECTIVE
To determine if prophylactic nasal continuous positive airways pressure (CPAP) commenced soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of chronic lung disease (CLD) without adverse effects.


METHODS
The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences, symposia, proceedings, expert informants, journal hand searching mainly in the English language.


METHODS
All trials using random or quasi-random patient allocation of very preterm infants < 32weeks gestation and / or < 1500 gms at birth were eligible. Comparison had to be between prophylactic nasal CPAP commencing soon after birth regardless of the respiratory status of the infant compared with "standard" methods of treatment where CPAP or IPPV is used for a defined respiratory condition.


METHODS
Standard methods of the Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each author, were used. Data were analysed using relative risk (RR).


RESULTS
There are no statistically significant differences in any of the outcomes reported in the single eligible study of 82 very low birth weight infants. More infants in the prophylactic nasal CPAP group received IPPV; however, this difference is not statistically significant. There are trends towards increases in the incidence of CLD (undefined) [RR 2.27 (0.77, 6.65)], of death [RR 3.63 (0.42, 31.08)] and of intraventricular hemorrhage [RR 2.18 (0.84, 5.62)] in the treatment group. The study also found a trend towards a reduction in the incidence of necrotizing enterocolitis in the treatment group [RR 0.40 (0.13, 1.21)].


CONCLUSIONS
There is currently insufficient information to make recommendations for clinical practice. The single study reviewed showed no strong evidence of benefit in reducing the incidence of IPPV. The tendency for some adverse outcomes to be increased is of concern and more data are needed to clarify this. A multicentre randomized controlled trial comparing prophylactic nasal CPAP with "standard" methods of treatment is needed to clarify its clinical role.
Subramaniam
P
P
NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006. dhs@mail.usyd.edu.au
Henderson-Smart
D J
DJ
Davis
P G
PG
D002908:Chronic Disease; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D008171:Lung Diseases / Q000517:prevention & control*; D011175:Positive-Pressure Respiration