Abstract 1309

Different therapeutic strategies have been recommended for ELBW infants. Minitouch regimen (permissive hypercapnia, early nCPAP, minimal handling), is commonly applied in Scandinavian centers. Doubts have been raised about the potential risk of such an approach with special regard to the incidence of cerebral haemorrhage and air leak. We report the incidence of intact survival in a group of 30 ELBWI (birth weight ≤1000 g) referred to our NICU during the last year (march 1997-march 1998). The cornerstones in the management of ELBWI in our center are permissive hypercapnia and extensive use of NCPAP (Infant Flow® System). Neonatal respiratory care differs on the basis of gestational age: GA ≤28 wks (group 1): prophylactic use of surfactant → SIMV → extubation in NCPAP when FiO2 ≤0.3 and RR=20b/min; GA >28 wks (group 2): use of early NCPAP if signs of respiratory distress and oxygen requirement >0.3. NCPAP failure criteria are: intractable apnoea, PaCO2 > 70 mmHg and pH < 7.2, O2 requirement > 0.6-0.8, if radiologic signs of RDS are present or absent, respectively. HFOV is used as rescue therapy in case of severe RDS unresponsive to FiO2=1.0, MAP≥12 cmH2O. Criteria for defining intact survival are: absence of cerebral haemorrhage grade >II, absence of ROP >II, absence of cystic PVL or cerebral infarction, hospital discharge without need of oxygen supply. Casistic: neonatal data are shown in table 1. Results: are shown in table 2. Six newborns died, 2 during surfactant administration, one for cardiac failure, and 3 for sepsis. One infant of 25 weeks of gestation was not intubated at birth owing to the good clinical picture and received only NCPAP. Two infants of group 1 were treated with HFOV for a maximum of 72 hours. The median value of hospital stay length was 99.5days (range 50-150). Discussion: Our data show a high incidence of intact survival in ELBWI managed with a conservative ventilator therapy. This management has permitted short times of mechanical ventilation (MV) without an increased incidence of complications, in particular cerebral haemorrhage (2 newborns in group 1).

Table 1 No caption available.
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Table 2 No caption available.
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