Oxygenation and ventilation in spontaneously breathing very preterm infants with nasopharyngeal CPAP in the delivery room.
OBJECTIVE
To provide data on ventilation, oxygenation and acid-base state from birth to 48 h in very preterm infants treated with lung recruitment manoeuvre and nasopharyngeal continuous positive airway pressure in the delivery room.


METHODS
Subjects of this prospective observational cohort study were 48 of 61 infants enrolled in a randomised controlled trial to test two lung recruitment manoeuvres after birth. The infants had received an arterial line in the delivery room. The outcome measures were data on oxygenation, ventilation and acid-base state during spontaneous breathing.


RESULTS
Data are presented as (n [%]; median [minimum-maximum]). 22 of 48 (46%) infants (gestational age, 26.4 [25.0-28.9] weeks; birth weight 870 [540-1310] g) were never intubated during the study. The FiO(2) of these infants was low (0.4 [0.21-0.45] at 45 min and 0.21 [0.21-0.5] at 48 h). PCO(2) reached its maximum at 24 (11-44) min (8 [6.4-10.8] kPa) and decreased below 6.7 kPa (median) within 3 h. The incidence of intracranial haemorrhage/periventricular leukomalacia did not increase with hypercapnia (pCO(2) > 8 kPa).


CONCLUSIONS
A transient period of hypercapnia after birth may occur in spontaneously breathing very preterm infants supported with nasopharyngeal continuous positive airway pressure in the delivery room. The incidence of cerebral damage was not increased in infants with hypercapnia.
Lindner
Wolfgang
W
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany. wolfgang.lindner@medizin.uni-ulm.de
Pohlandt
Frank
F
D000136:Acid-Base Equilibrium; D001784:Blood Gas Analysis; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D009305:Nasopharynx; D010102:Oxygen Inhalation Therapy; D011247:Pregnancy; D011446:Prospective Studies; D012119:Respiration; D012121:Respiration, Artificial; D016896:Treatment Outcome; D014469:Umbilical Arteries