title: Incidence and Outcome of CPAP Failure in Preterm Infants.
abstract: Data from clinical trials support the use of continuous positive airway pressure (CPAP) for initial respiratory management in preterm infants, but there is concern regarding the potential failure of CPAP support. We aimed to examine the incidence and explore the outcomes of CPAP failure in Australian and New Zealand Neonatal Network data from 2007 to 2013.
  
  
  
  Data from inborn preterm infants managed on CPAP from the outset were analyzed in 2 gestational age ranges (25-28 and 29-32 completed weeks). Outcomes after CPAP failure (need for intubation <72 hours) were compared with those succeeding on CPAP using adjusted odds ratios (AORs).
  
  
  
  Within the cohort of 19 103 infants, 11 684 were initially managed on CPAP. Failure of CPAP occurred in 863 (43%) of 1989 infants commencing on CPAP at 25-28 weeks' gestation and 2061 (21%) of 9695 at 29-32 weeks. CPAP failure was associated with a substantially higher rate of pneumothorax, and a heightened risk of death, bronchopulmonary dysplasia (BPD) and other morbidities compared with those managed successfully on CPAP. The incidence of death or BPD was also increased: (25-28 weeks: 39% vs 20%, AOR 2.30, 99% confidence interval 1.71-3.10; 29-32 weeks: 12% vs 3.1%, AOR 3.62 [2.76-4.74]). The CPAP failure group had longer durations of respiratory support and hospitalization.
  
  
  
  CPAP failure in preterm infants is associated with increased risk of mortality and major morbidities, including BPD. Strategies to promote successful CPAP application should be pursued vigorously.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia; peter.dargaville@dhhs.tas.gov.au.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Dargaville
authors.affiliation: Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia;
authors.forename: Angela
authors.initials: A
authors.lastname: Gerber
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Solna, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden;
authors.forename: Stefan
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia;
authors.forename: Antonio G
authors.initials: AG
authors.lastname: De Paoli
authors.affiliation: Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and.
authors.forename: C Omar F
authors.initials: CO
authors.lastname: Kamlin
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Francesca
authors.initials: F
authors.lastname: Orsini
authors.affiliation: Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D045422:Continuous Positive Airway Pressure; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012307:Risk Factors; D017211:Treatment Failure