title: [The use of the continuous positive airway pressure for early stabilization in very low birthweight infants].
abstract: BACKGROUND
  The introduction of continuous positive airway pressure (CPAP) in neonatal units provides a new strategy in the management of infants weighing less than 1500 g, and especially in those weighing less than 1000 g, allowing a reduction in the use of surfactant without negatively affecting prognosis.
  
  
  OBJECTIVE
  To compare the rate of surfactant use in very low birthweight (VLBW) infants before and after the introduction of CPAP for early stabilization. To compare the frequency of pneumothorax, bronchopulmonary dysplasia (BPD), mortality, severe brain injury, length of hospital stay, and days of intubation in both groups of VLBW infants.
  
  
  METHODS
  We performed a before-after study comparing VLBW infants born in a tertiary care hospital in two periods: group 1 consisted of 78 VLBW infants born in 2001 and group 2 consisted of 80 VLBW infants born from June 2003 to February 2004. Group 1 received conventional management (intubation and administration of surfactant in the delivery room). In group 2, CPAP was introduced for early stabilization.
  
  
  RESULTS
  The mean weight was 1059+/-309 g in group 1 and 1127+/-295 g in group 2 (p = 0.15). The mean gestational age was 29 +/- 3.3 weeks in group 1 and 29 +/- 2.8 weeks in group 2 (p = 1). Fifty-four percent of the neonates in group 1 were intubated in the delivery room versus 31 % of those in group 2 (p = 0.004). Surfactant was used in 68 % of neonates in group 1 versus 49 % of those in group 2 (RR = 1.34 [1.06-1.83]). The mean number of days of intubation was 4 +/- 11 in group 1 versus 2.7 6 5.8 in group 2 (p 5 0.15). Bronchopulmonary dysplasia at a corrected age of 36 weeks occurred in 19 % of neonates in group 1 and in 14.5 % of those in group 2 (RR = 1.34 [0.63-2.84]). The mean number of days on oxygen was 34 6 47 and 21 6 25 respectively (p = 0.04). Necrotizing enterocolitis occurred in 3.8 % of neonates in group 1 and in 8.7 % of those in group 2 (RR= 0.43 [0.11-1.63]). The mortality rate and frequency of pneumothorax were similar in both groups. In the subgroup of VLWB infants with a gestation age of < 28 weeks, no differences were found between the two periods.
  
  
  CONCLUSIONS
  The use of CPAP for early stabilization of VLBW infants is not associated with an increase in neonatal morbidity. This therapy allows the use of surfactant to be decreased, and even allows the number of days on oxygen to be reduced, without adverse effects. However, data on long-term follow-up are not yet available.
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España. mariamaestro@telefonica.net
authors.forename: M
authors.initials: M
authors.lastname: López Maestro
authors.forename: C R
authors.initials: CR
authors.lastname: Pallás Alonso
authors.forename: Maria C
authors.initials: MC
authors.lastname: Muñoz Labián
authors.forename: Maria C
authors.initials: MC
authors.lastname: Barrio Andrés
authors.forename: C
authors.initials: C
authors.lastname: Medina López
authors.forename: J
authors.initials: J
authors.lastname: de la Cruz Bértolo
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D011663:Pulmonary Surfactants