title: [Nasal CPAP versus mechanical ventilation in 28 to 32-week preterm infants with early surfactant administration].
abstract: BACKGROUND
  Continuous positive airway pressure (CPAP) is useful in low birth weight infants with respiratory distress, but it is not known if it is a better alternative to mechanical ventilation after early pulmonary surfactant administration.
  
  
  OBJECTIVE
  To compare the incidence of adverse events in 28 to 32-week newborns with respiratory distress managed with mechanical ventilation or CPAP after early surfactant administration.
  
  
  METHODS
  In total, 176 newborns were treated with CPAP and 147 with mechanical ventilation, all with Apgar scores >3 at five minutes and without apnea.
  
  
  RESULTS
  The incidence of CPAP failure was 6.5% (95% CI: 11.3-22.8%); 29 patients died: 7 with CPAP (4.0%) and 22 with mechanical ventilation (15.0%, p<0.001). The relative risk of dying with CPAP versus mechanical ventilation was 0.27 (95% CI: 0.12-0.61), but after adjusting for confounding factors, CPAP use did not imply a higher risk of dying (RR=0.60; 95% CI: 0.29-1.24). Mechanical ventilation fatality rate was 5.70 (95% CI: 3.75-8.66) deaths/1,000 days-patient, while with CPAP it was 1.37 (95% CI: 0.65-2.88, p<0.001). Chronic lung disease incidence was lower with CPAP than with mechanical ventilation (RR=0.71; 95% CI: 0.54-0.96), as were intracranial hemorrhage (RR=0.28, 95% CI: 0.09-0.84) and sepsis (RR=0.67; 95%CI: 0.52-0.86), and it was similar for air leaks (RR=2.51; 95% CI: 0.83-7.61) and necrotizing enterocolitis (RR=1.68, 95% CI: 0.59-4.81).
  
  
  CONCLUSIONS
  CPAP exposure of premature infants with respiratory distress syndrome is protective against chronic lung disease, intraventricular hemorrhage and sepsis compared to mechanical ventilation. No differences were observed regarding air leak syndrome or death.
authors.affiliation: Unidad Neonatal, Departamento de Pediatría, Departamento de Pediatría, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
authors.forename: Luis Alfonso
authors.initials: LA
authors.lastname: Pérez
authors.affiliation: Programa de Especialización en Pediatría, Departamento de Pediatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
authors.forename: Diana Marcela
authors.initials: DM
authors.lastname: González
authors.affiliation: Programa de Especialización en Pediatría, Departamento de Pediatría, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
authors.forename: Karen Margarita de Jesús
authors.initials: KM
authors.lastname: Álvarez
authors.affiliation: Departamento de Pediatría, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
authors.forename: Luis Alfonso
authors.initials: LA
authors.lastname: Díaz-Martínez
mesh_terms: D000328:Adult; D001034:Apgar Score; D001688:Biological Products / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D002908:Chronic Disease; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D007442:Intubation, Intratracheal; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008478:Mediastinal Emphysema / Q000453:epidemiology / Q000209:etiology; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; C072197:beractant