title: Early nasal continuous positive airway pressure and low threshold for intubation in very preterm infants.
abstract: 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.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.b.te_pas@lumc.nl
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Spaans
authors.forename: Monique
authors.initials: M
authors.lastname: Rijken
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Morley
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Walther
mesh_terms: 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*
chemical_list: D011663:Pulmonary Surfactants