Variables associated with the early failure of nasal CPAP in very low birth weight infants.
OBJECTIVE
To identify risk factors and neonatal outcomes associated with the early failure of "bubble" nasal continuous positive airway pressure (CPAP) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS).


METHODS
Following resuscitation and stabilization at delivery, a cohort of 261 consecutively inborn infants (birth weight < or = 1250 g) was divided into three groups based on the initial respiratory support modality and outcome at 72 hours of age: "ventilator-started" group, "CPAP-failure" group, and "CPAP-success" group.


RESULTS
CPAP was successful in 76% of infants < or = 1250 g birth weight and 50% of infants < or = 750 g birth weight. In analyses adjusted for postmenstrual age (PMA) and small for gestational age (SGA), CPAP failure was associated with need for positive pressure ventilation (PPV) at delivery, alveolar-arterial oxygen tension gradient (A-a DO2) >180 mmHg on the first arterial blood gas (ABG), and severe RDS on the initial chest x-ray (adjusted odds ratio [95% CI] = 2.37 [1.02, 5.52], 2.91 [1.30, 6.55] and 6.42 [2.75, 15.0], respectively). The positive predictive value of these variables ranged from 43% to 55%. In analyses adjusted for PMA and severe RDS, rates of mortality and common premature morbidities were higher in the CPAP-failure group than in the CPAP-success group.


CONCLUSIONS
Although several variables available near birth were strongly associated with early CPAP failure, they proved weak predictors of failure. A prospective controlled trial is needed to determine if extremely premature spontaneously breathing infants are better served by initial management with CPAP or mechanical ventilation.
Ammari
Amer
A
Division of Neonatology-Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York 10032-3702, USA.
Suri
Mandhir
M
Milisavljevic
Vladana
V
Sahni
Rakesh
R
Bateman
David
D
Sanocka
Ulana
U
Ruzal-Shapiro
Carrie
C
Wung
Jen-Tien
JT
Polin
Richard A
RA
D001724:Birth Weight; D045422:Continuous Positive Airway Pressure; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007442:Intubation, Intratracheal; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure
D011663:Pulmonary Surfactants