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.

  • Original Article
  • Published:

Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation

Journal of Perinatology volume 33, pages 297–301 (2013)Cite this article

Subjects

Abstract

Objective:

To identify variables associated with early nasal continuous positive airway pressure (ENCPAP) failure in preterm neonates less than 30 weeks gestational age.

Study Design:

Multicenter prospective study including 131 preterm newborns, over a period of 2 years. Patients and respiratory variables were assessed using univariate analysis.

Result:

Variables associated with ENCPAP failure were: the need of resuscitation with a FiO2>0.30; a CPAP pressure of 6.4±1.2 cm H2O; the need of a FiO2 of 0.40 in the first 4 h of life; male gender maintaining the need of a FiO2>0.25 in the first 4 h of life; and respiratory distress syndrome with criteria for surfactant administration.

Conclusion:

The need for oxygen in resuscitation and maintained in first hours of life, male gender, a CPAP pressure over 5 cm H2O and surfactant need are predictors of ENCPAP failure in preterm neonates 26 to 30 weeks gestational age.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Donn SM, Sinha SK . Assisted ventilation and its complications In: Martin RJ, Fanaroff AA, Walsh MC (eds). Fanaroff and Martin’s Neonatal-Perinatal Medicine. Diseases of the Fetus and Infant, 9th edn. Elsevier Mosby: St Louis, Missouri, 2011, pp 1116–1140.

    Google Scholar 

  2. Bjorklund LJ, Ingimarsson J, Cursted T, John J, Robertson B, Werner O et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res 1997; 42: 348–355.

    Article  CAS  PubMed  Google Scholar 

  3. Wada K, Jobe AH, Ikegami M . Tidal volume effects on surfactant treatment responses with the initiation of ventilation in preterm infants. J Appl Physiol 1997; 83: 1054–1061.

    Article  CAS  PubMed  Google Scholar 

  4. Ikegami M, Kallapur S, Michna J, Jobe AH . Lung injury and surfactant metabolism after hyperventilation of premature lambs. Pediatr Res 2000; 47: 398–404.

    Article  CAS  PubMed  Google Scholar 

  5. 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  PubMed  Google Scholar 

  6. Thomson MA, Yoder BA, Winter VT, Martin H, Catland D, Siler-Khodr TM et al. Treatment of immature baboons for 28 days with early nasal continuous positive airway pressure. Am J Respir Crit Care Med 2004; 169: 1054–1062.

    Article  PubMed  Google Scholar 

  7. Ingimarsson J, Bjorklund LJ, Cursted T, Gudmundsson S, Larsson A, Robertson B et al. Incomplete protection by prophylactic surfactant against the adverse effects of large lung inflations at birth in immature lambs. Intensive Care Med 2004; 30: 1446–1453.

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  9. Dunn MS, Reilly MC . Approaches to the initial respiratory management of preterm neonates. Paediatr Respir Rev 2003; 4: 2–8.

    Article  PubMed  Google Scholar 

  10. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB . Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358: 700–708.

    Article  CAS  PubMed  Google Scholar 

  11. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362: 1970–1979.

    Article  CAS  PubMed  Google Scholar 

  12. Ammari A, Suri M, Milisavljevic V, Sahni R, Bateman D, Sanocka U et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr 2005; 147: 341–347.

    Article  PubMed  Google Scholar 

  13. Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD . Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of<29 weeks gestational age. Arch Dis Child Fetal Neonatal Ed 2011; 96: F343–F347.

    Article  CAS  PubMed  Google Scholar 

  14. De Jaegere AP, van der Lee JH, Canté C, van Kaam AH . Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation. Acta Paediatr 2012; 101 (4): 374–379.

    Article  PubMed  Google Scholar 

  15. Bohlin K . RDS—CPAP or surfactant or both. Acta Paediatr Suppl 2012; 101: 24–28.

    Article  Google Scholar 

  16. MacDonald H . American Academy of Pediatrics. Committee on fetus and newborn perinatal care at the threshold of viability. Pediatrics 2002; 110: 1024–1027.

    Article  PubMed  Google Scholar 

  17. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R . New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417–423.

    Article  CAS  PubMed  Google Scholar 

  18. Fenton TR . A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Couchard M, Polge J, Bomsel F . Hyaline membrane disease; diagnosis, radiological surveillance, treatment and complications. Ann Radiol (Paris) 1974; 17: 669–683.

    CAS  Google Scholar 

  20. Jobe A, Bancalari E . NICHD/NHLBI/ORD workshop summary—bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  PubMed  Google Scholar 

  21. Blanc WA . Pathology of the placenta, membranes, and umbilical cord in bacterial, fungal, and viral infections in man In: Naeye RL, Kissane JM (eds). International Academy of Pathology Monograph. Perinatal Diseases by 14 authors. Williams and Willkins: Baltimore, 1981.

    Google Scholar 

  22. Walsh MC, Kliegman RM . Necrotizing enterocolitis: treatment based on staging criteria. Ped Clin N Am 1986; 33: 179–201.

    Article  CAS  Google Scholar 

  23. An international classification of retinopathy of prematurity. Pediatrics 1984; 74: 127–133.

  24. The international classification of retinopathy of prematurity revisited. International Committee for the Classification of Retinopathy of Prematurity. Arch Ophthalmol 2005; 123: 991–999.

  25. Papile LA, Burstein J, Burstein R . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500g. J Pediatr 1978; 92: 529–534.

    Article  CAS  PubMed  Google Scholar 

  26. de Vries L, Rennie JM . Preterm brain injury In: Rennie JM, Roberton NRC (eds). Textbook of Neonatology 3rd edn. Churchill Livingstone: London, 1999, pp 1252–1270.

    Google Scholar 

  27. Perlman JM, Risser R . Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adoesc Med 1995; 149: 20–25.

    Article  CAS  Google Scholar 

  28. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB et al. Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358: 700–708.

    Article  CAS  PubMed  Google Scholar 

  29. Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EF, Wright LL et al. Delivery room continuous positive airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial. Pediatrics 2004; 114: 651–657.

    Article  PubMed  Google Scholar 

  30. Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S et al. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 2010; 125: e1402–e1409.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Hospital de São João, Porto, Portugal

    G Rocha, F Flôr-de-Lima & H Guimarães

  2. Department of Neonatology, Centro Hospitalar do Porto, Porto, Portugal

    E Proença & C Carvalho

  3. Department of Pediatrics, Division of Neonatology, Centro Hospitalar de Vila Nova de Gaia, Porto, Portugal

    C Quintas

  4. Department of Pediatrics, Division of Neonatology, Hospital de Matosinhos, Porto, Portugal

    T Martins

  5. Department of Pediatrics, Division of Neonatology, Centro Hospitalar do Alto Ave, Guimarães, Portugal

    A Freitas & C Paz-Dias

  6. Department of Pediatrics, Division of Neonatology, Hospital de Braga, Braga, Portugal

    A Silva

  7. Faculty of Medicine of Porto University, Porto, Portugal

    H Guimarães

Authors
  1. G Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Flôr-de-Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E Proença
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Quintas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C Paz-Dias
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H Guimarães
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Rocha.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rocha, G., Flôr-de-Lima, F., Proença, E. et al. Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation. J Perinatol 33, 297–301 (2013). https://doi.org/10.1038/jp.2012.110

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.110

Keywords

This article is cited by

Search

Advanced search

Quick links