The increase of oxygen requirement as index to identify the infants at high risk of pneumothorax during nasal continuous positive airway pressure.
OBJECTIVE
The aim of this study was to evaluate the inspiration fraction of oxygen (FiO2) trend as an indicator of timing to suspend nasal continuous positive airway pressure (N-CPAP) and shift the babies to mechanical ventilation, in order to reduce the incidence of pneumothorax, comparing a similar population admitted in our division during the previous year.


METHODS
Seventy-five newborns (mean gestational age 33.5 weeks, mean birth weight 2,072 g) admitted during 2003 in our Neonatal Intensive Care Unit, treated with Infant Flow System Nasal-CPAP, were included. Patients with more than 40% increase of the starting FiO2 in the first 24 h of treatment, were intubated and shift on mechanical ventilation. Seventy-seven infants, admitted during the previous year, with similar characteristics (mean gestational age 33.7 weeks, mean birth weight 2,047 g) were considered as control.


RESULTS
Fifty-six neonates improved, 19 worsened and required mechanical ventilation. One of these developed pneumothorax (1.3%). Of the 77 infants admitted during the previous year, 26 worsened and were mechanically ventilated, and 8 developed pneumothorax (10.3%). The difference of incidence of pneumothorax was significant (P =0.0337).


CONCLUSIONS
An increase of FiO2 more than 40% of the initial value during the first 24 h of N-CPAP may be considered a useful marker to identify infants at high risk of pneumothorax.
Migliori
B
B
Neonatology and Neonatal Intensive Care Unit, Spedali Civili, Brescia, Italy. claudio.migliori@tin.it
Pontiggia
F
F
Chirico
G
G
D000367:Age Factors; D001724:Birth Weight; D045422:Continuous Positive Airway Pressure; D003627:Data Interpretation, Statistical; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010100:Oxygen / Q000097:blood; D011030:Pneumothorax / Q000453:epidemiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D012307:Risk Factors; D016896:Treatment Outcome
D010100:Oxygen