title: Risk Indicators for Air Leaks in Preterm Infants Exposed to Restrictive Use of Endotracheal Intubation.
abstract: OBJECTIVE
  To identify perinatal risk indicators for air leaks in preterm infants treated with a policy of restrictive use of endotracheal intubation based on sustained inflations followed by noninvasive ventilation in the delivery room.
  
  
  METHODS
  Perinatal variables and variables of respiratory support in the delivery room were analyzed retrospectively in a cohort of 297 inborn preterm infants with a gestational age <29 weeks born in 2005-2009 in a tertiary care center with respect to their associations with air leaks. Multivariate logistic regression analysis was performed to analyze independent risk indicators.
  
  
  RESULTS
  Gestational age was 26 weeks + 0 days (22+3 to 28+6), birth weight was 790 g (265-1,660) and 270/297 survived (91.0%). A total of 63 (21.2%) developed air leaks, 32 (10.8%) pneumothorax, 44 (14.8%) pulmonary interstitial emphysema, and 1 (0.3%) pneumopericardium. The infants with air leaks had a higher risk of death (p < 0.01) and of intraventricular hemorrhage grade 3/4 (p < 0.05). Air leaks were associated with less use of prenatal steroids (p < 0.01), more frequent use of cardiac compressions (p < 0.01), use of a pressure of 30 cm H2O for sustained inflations (p < 0.05), and intubation in the delivery room (p < 0.01). After multivariate logistic regression only prenatal steroids (OR 0.41, 0.20-0.85), epinephrine (OR 3.56, 1.55-8.15) and surfactant use (OR 12.03, 3.39-42.72) remained significant.
  
  
  CONCLUSIONS
  Our approach resulted in a high survival rate but was associated with a substantial rate of air leaks, which were associated with death and severe intraventricular hemorrhage. Prenatal steroids were protective, and epinephrine and surfactant use were significant risk indicators, whereas the use of sustained inflations was not a risk factor.
authors.affiliation: Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, Children's Hospital, University of Ulm, Ulm, Germany.
authors.forename: Helmut D
authors.initials: HD
authors.lastname: Hummler
authors.forename: Elisa
authors.initials: E
authors.lastname: Parys
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mayer
authors.forename: Jochen
authors.initials: J
authors.lastname: Essers
authors.forename: Hans
authors.initials: H
authors.lastname: Fuchs
authors.forename: Manuel
authors.initials: M
authors.lastname: Schmid
mesh_terms: D001724:Birth Weight; D003696:Delivery Rooms; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011026:Pneumopericardium / Q000628:therapy*; D011656:Pulmonary Emphysema / Q000628:therapy*; D011663:Pulmonary Surfactants / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D062606:Tertiary Care Centers
chemical_list: D011663:Pulmonary Surfactants