Early nasal continuous positive airway pressure and low threshold for intubation in very preterm infants.
OBJECTIVE
To determine if selective intubation, use of early nasal continuous positive airway pressure (NCPAP) at birth with a low threshold for early surfactant treatment, reduces the need for intubation in very preterm infants in the first days after birth.


METHODS
Two cohorts of very preterm infants < or = 32 weeks, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (1996-1997) and after (2003-2004) introducing selective intubation and use of early NCPAP. A FiO(2)> or = 0.40 was used as criterion for intubation. Primary outcome measure was intubation < 72 h of age. Bronchopulmonary dysplasia (BPD) was a secondary outcome.


RESULTS
The rate of intubation in the delivery room (69% vs. 46%, p < 0.001) and within 72 h of age (73% vs. 57%, p < 0.001) was lower following the change in policy. Early NCPAP was, in 2003-2004, increasingly used as primary treatment (10% vs. 33%, p < 0.001) with higher maximum NCPAP levels (4.0 (0.9) vs. 5.8 (1.5), p < 0.001). There was no change in BPD (14.3% vs. 15.2%, p = 0.82).


CONCLUSIONS
Avoiding intubation by using early NCPAP while maintaining a low-threshold for surfactant treatment decreased the need for intubation.
te Pas
Arjan B
AB
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.b.te_pas@lumc.nl
Spaans
Vivian M
VM
Rijken
Monique
M
Morley
Colin J
CJ
Walther
Frans J
FJ
D000465:Algorithms; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*
D011663:Pulmonary Surfactants