Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Early Bubble CPAP and Outcomes in ELBW Preterm Infants

Abstract

OBJECTIVE: To test whether the introduction of early bubble continuous positive airway pressure (CPAP) results in improved respiratory outcomes in extremely low birth-weight infants.

STUDY DESIGN: Outcomes of all infants between 401 and 1000 g born in a level 3 neonatal intensive care units (NICU) between July 2000 and October 2001 (period 2) were compared using historical controls (period 1). Early bubble (CPAP) was prospectively introduced in the NICU during period 1. Univariate and adjusted comparisons were made across time periods.

RESULTS: Delivery room intubations, days on mechanical ventilation and use of postnatal steroids decreased (p<0.001) in period 2, while mean days on CPAP, number of babies on CPAP at 24 hours (p<0.001) and mean weight at 36 weeks corrected gestation also increased (p<0.05) after introduction of early bubble CPAP.

CONCLUSIONS: Early bubble CPAP reduced delivery room intubations, days on mechanical ventilation, postnatal steroid use and was associated with increased postnatal weight gain with no increased complications.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. Avery ME, Tooley WH, Keller JB, Hurd SS, Bryan MH, Cotton RB . Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 1987;79:26–30.

    CAS  PubMed  Google Scholar 

  2. Van Marter LJ, Allred EN, Pagano M, et al. Do clinical markers of barotraumas and oxygen toxicity explain interhospital variation in rates of chronic lung disease? Pediatrics 2000;105:1194–1201.

    CAS  Article  Google Scholar 

  3. Northway WH, Rosan RC, Porter DY . Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967;276:357–368.

    Article  Google Scholar 

  4. Jobe AH, Ikegami M . Prevention of bronchopulmonary dysplasia. Curr opin Pediatr 2001;13:124–129.

    CAS  Article  Google Scholar 

  5. Lindner W, Vossbeck S, Hummler H, Pohlandt F . Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Pediatrics 1999;103:961–967.

    CAS  Article  Google Scholar 

  6. Gitterman MK, Fusch C, Gitterman AR, Regazzoni BM, Moessinger AC . Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants. Eur J Pediatr 1997;156:384–3888.

    Article  Google Scholar 

  7. Jobe AH, Kramer BW, Moss TJ, Newnham JP, Ikegami M . Decreased indicators of lung injury with continuous positive expiratory pressure in preterm lambs. Pediatr Res 2002;52:387–392.

    Article  Google Scholar 

  8. Kyong-Soon Lee, Dunn MS, Fenwick M, Shennan AT . A comparison of underwater bubble CPAP with ventilator derived CPAP in premature neonates ready for extubation. Biol Neonate 1998;73:69–75.

    Article  Google Scholar 

  9. Stevens TP, Blennow M, Soll RF . Early Surfactant Adminstration with Brief Ventilation vs Selective Surfactant and Continued Mechanical Ventilation for Preterm Infants with or at Risk for RDS. The Cochrane Library, Issue 2. Oxford: Update Software Ltd., 2002.

  10. Wright LL, McNellis D . National Institute of Child Health and Human Development sponsored perinatal research networks. Semin Perinatol 1995;19(2):112–123.

    CAS  Article  Google Scholar 

  11. Gregory GA, Kitterman JA, Phibbs RH, Tooley WA, Hamilton WK . Treatment of the idiopathic respiratory distress system with continuous positive airway pressure. N Engl J Med 1971;284:1333–1340

    CAS  Article  Google Scholar 

  12. Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG . Continuous Distending Pressure for Respiratory Distress Syndrome in Preterm Infants. The Cochrane Library, Issue 2. Oxford: Update Software Ltd., 2002.

  13. Davis PG, Henderson-Smart DJ . Nasal continous positive airway pressure immediately after extubation for preventing morbidity in preterm infants. The Cochrane Library, Issue 2. Oxford: Update Software Ltd., 2002.

  14. Poets CF, Sens B . Changes in intubation rates and outcome of very low birth weight infants: a population based study. Pediatrics 1996;98:24–27

    CAS  PubMed  Google Scholar 

  15. Kamper J, Wulff K, Larsen C, Lindequist S . Early treatment with nasal continuous positive airway pressure in very low-birth weight infants. Acta Paediatr Scand 1993;82:193–197.

    CAS  Article  Google Scholar 

  16. Lundstrom KE, Griesen G . Early treatment with nasal-CPAP. Acta Paediatr Scand 1993;82:856.

    CAS  Article  Google Scholar 

  17. Ho JJ, Henderson-Smart DJ, Davis PG . Early vs Delayed Initiation of Continuous Distending Pressure for Respiratory Distress Syndrome in Preterm Infants. The Cochrane Library, Issue 2. Oxford: Update Software Ltd., 2002.

  18. Verder H, Albertsen P, Ebbesen F, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks gestation. Pediatrics 1999;103(2):E25.

    Article  Google Scholar 

  19. Merran AT (IFDAS study group). Early nasal continuous positive airway pressure with prophylactic surfactant for neonates at risk of RDS. The IFDAS multi-center randomized trial. Pediatr Res 2002;51(4):379A.

    Google Scholar 

  20. Mariani G, Cifuentes J, Carlo WA . Randomised trial of permissive hypercapnia in preterm infants. Pediatrics 1999;104:1082–1088.

    CAS  Article  Google Scholar 

  21. Shibata K, Cregg N, Engelberts D, Takeuchi A, Fedorko L, Kavanagh BP . Hypercapnic acidosis may attenuate acute lung injury by inhibition of endogenous xanthine oxidase. Am J Respir Crit Care Med 1998;158:1578–1584.

    CAS  Article  Google Scholar 

  22. Sanocka U, Durkin M, Chiroboga C, Kuban K, Hinton V, VanMarter L, Bellinger D . Variations in respiratory management of VLBW infants: Effects on long term outcomes. Pediatr Res 2002;51(4):289A.

    Google Scholar 

  23. Wung JT . Respiratory management for low birth weight infants. Crit Care Med 1993;21(9 Suppl):S364–s365.

    CAS  Article  Google Scholar 

  24. Klerk AD, Klerk RD . Nasal continuous positive airway pressure and outcomes of preterm infants. J Paediatr Child Health 2001;37:161–167.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Narendran, V., Donovan, E., Hoath, S. et al. Early Bubble CPAP and Outcomes in ELBW Preterm Infants. J Perinatol 23, 195–199 (2003). https://doi.org/10.1038/sj.jp.7210904

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7210904

Further reading

Search

Quick links