[Early application of CPAP in newborns with gestational age below 34 weeks lowers intubation rate and shortens oxygen therapy without altering mortality and morbidity].
OBJECTIVE
The aim of this study was to test the following hypotheses: the application of early CPAP in the treatment of RDS decreases both the intubation rate and the incidence of bronchopulmonary dysplasia.


METHODS
This retrospective study compares the ventilatory management of premature infants between two periods of 12 months. The first period (July 1996-June 1997) precedes the application of early CPAP, the second (July 1998-June 1999) follows the systematic introduction of early CPAP.


METHODS
All inborn infants, < 34 weeks gestational age and admitted in the Division of Neonatology, CHUV, Lausanne, are included.


RESULTS
The intubation rate was reduced significantly from 63.6% in the first period to 23.8% in the second and, if we only consider infants < or = 1500 g, from 72.1 to 30.8% (p < 0.01). The incidence of bronchopulmonary dysplasia, defined as the persistence of oxygen needs at 28 days of life, decreases from 10% in the first period to 4.8% in the second period and, if we only consider infants < or = 1500 g, from 14.7 to 7.7%. These differences are not significant. However we noticed a significant decrease in the duration of O2 therapy from 8.8 days in the first period to 4.6 days in the second (p = 0.04). If we only consider infants < or = 1500 g, the O2 therapy lasted 12.1 days for the first period and 6.8 days for the second. This decrease is not significant. Mortality is identical for both periods: survival rate is 90% in the first period and 90.5% in the second, and 85% and 86.2% respectively if we only consider infants < or = 1500 g. We noticed no significant differences in the morbidity rate (intraventricular haemorrhage, leucomalacia, retinopathy of prematurity and patent ductus arteriosus), except that for infants < or = 1500 g the incidence of pneumothorax was higher in the second period.


CONCLUSIONS
The application of early CPAP significantly reduces the intubation rate without increasing mortality. A decrease in the incidence of bronchopulmonary dysplasia was observed but this finding was not statistically significant.
Joris
N
N
Division de néonatologie du Département médico-chirurgical de Pédiatrie, CHUV Avenue Pierre-Decker, CH-1011 Lausanne. njoris@hotmail.com
Sudre
P
P
Moessinger
A
A
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D009017:Morbidity; D011175:Positive-Pressure Respiration; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors