Early respiratory management of respiratory distress syndrome in very preterm infants and bronchopulmonary dysplasia: a case-control study.
BACKGROUND
In the period immediately after birth, preterm infants are highly susceptible to lung injury. Early nasal continuous positive airway pressure (ENCPAP) is an attempt to avoid intubation and may minimize lung injury. In contrast, ENCPAP can fail, and at that time surfactant rescue can be less effective.


OBJECTIVE
To compare the pulmonary clinical course and outcome of very preterm infants (gestational age 25-32 weeks) with respiratory distress syndrome (RDS) who started with ENCPAP and failed (ECF group), with a control group of infants matched for gestational age, who were directly intubated in the delivery room (DRI group). Primary outcome consisted of death during admission or bronchopulmonary dysplasia (BPD).


RESULTS
25 infants were included in the ECF group and 50 control infants matched for gestational age were included in the DRI group. Mean gestational age and birth weight in the ECF group were 29.7 weeks and 1,393 g and in the DRI group 29.1 weeks and 1,261 g (p = NS). The incidence of BPD was significantly lower in the ECF group than in the DRI group (4% vs. 35%; P<0.004; OR 12.6 (95% CI 1.6-101)). Neonatal mortality was similar in both groups (4%). The incidence of neonatal morbidities such as severe cerebral injury, patent ductus arteriosus, necrotizing enterocolitis and retinopathy of prematurity, was not significantly different between the two groups.


CONCLUSIONS
A trial of ENCPAP at birth may reduce the incidence of BPD and does not seem to be detrimental in very preterm infants. Randomized controlled trials are needed to test whether early respiratory management of preterm infants with RDS plays an important role in the development of BPD.
Te Pas
Arjan B
AB
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.b.te_pas@lumc.nl
Lopriore
Enrico
E
Engbers
Marissa J
MJ
Walther
Frans J
FJ
D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D019468:Disease Management; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D007440:Intubation / Q000009:adverse effects; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D011663:Pulmonary Surfactants