title: Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth.
abstract: OBJECTIVE
  To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP) during the first 48 hours after birth.
  
  
  METHODS
  Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.7) weeks failed CPAP and 17 infants with a GA of 30.1 (0.4) weeks did not fail CPAP. Frequency, duration and tidal volumes (VT) of expiratory holds (EHs), peak inspiratory flows, CPAP-level and FiO2-levels were analysed.
  
  
  RESULTS
  EH incidence increased <6 minutes after birth and remained stable thereafter. EH peak inspiratory flows and VT were similar between CPAP-fail and CPAP-success infants. At 9-12 minutes, CPAP-fail infants more frequently used smaller VTs, 0-9 ml/kg and required higher peak inspiratory flows. However, CPAP-success infants often used large VTs (>9 ml/kg) with higher peak inspiratory flows than CPAP-fail infants (71.8 ± 15.8 vs. 15.5 ± 5.2 ml/kg.s, p <0.05). CPAP-fail infants required higher FiO2 (0.31 ± 0.03 vs. 0.21 ± 0.01), higher CPAP pressures (6.62 ± 0.3 vs. 5.67 ± 0.26 cmH2O) and more positive pressure-delivered breaths (45 ± 12 vs. 19 ± 9%) (p <0.05).
  
  
  CONCLUSIONS
  At 9-12 minutes after birth, CPAP-fail infants more commonly used lower VTs and required higher peak inspiratory flow rates while receiving greater respiratory support. VT was less variable and larger VT was infrequently used reflecting early signs of fatigue.
authors.affiliation: The Ritchie Centre, MIMR-PHI, Monash University, Clayton, Australia.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Siew
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van Vonderen
authors.affiliation: The Ritchie Centre, MIMR-PHI, Monash University, Clayton, Australia.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Hooper
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D045422:Continuous Positive Airway Pressure; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D005740:Gases / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008168:Lung / Q000378:metabolism; D008297:Male; D010100:Oxygen / Q000378:metabolism; D036801:Parturition; D012119:Respiration; D013990:Tidal Volume
chemical_list: D005740:Gases; D010100:Oxygen