Background: Benefit and tolerance of early nCPAP, applied in the delivery room, in combination with surfactant therapy are still discussed in the management of respiratory distress syndrome (RDS) in extremely low birth weight infants (ELBWI) Objective: To assess the feasability and safety of early nCPAP in combination with early curative surfactant therapy (nCPAP + surfactant) in less than 28 wks gestational age (GA) preterm infants and its eventual effects on neonatal morbidity.
Design/Methods: Outcomes of two groups of preterm infants with GA <28 wks (commonly managed by nCPAP in the delivery room (DR)), admitted in our NICU from January 1999 to December 2002 were compared before (period I: 1999,2000; n = 92) and after (period II: 2001,02; n =119) the adoption of early nCPAP + surfactant policy, for the treatment of RDS. Such strategy was proposed electively to preterm infants unaffected by hemodynamic failure, apnea or metabolic acidosis (pH <7.20).
Results: (mean +/−SD) GA and birth weight (BW) during period II were lower in comparison with period I: 26.5 +/−1.3 vs 27 +/− 1 wks (p<0.05) and 895 +/− 197g vs 940+/− 239, respectively. Administration of antenatal steroids (complete curse) was not different between the two periods, 51 % (period I) vs 58 % (period II). 80 % and 78 % of preterm infants within periods I and II received surfactant therapy respectively. The number of infants managed with early nCPAP + surfactant for RDS was higher during period II, 7 vs 28 % (p<0.005). GA and BW of such patients (n = 30) were 26.6 +/− 1.3 wks and 876 +/− 182g. The number of preterm infants receiving MV, within the first week of life, was lower during period II: 61 % vs 75 % (p<0.05). No infant managed with nCPAP had pneumothorax. The incidence of bronchopulmonary dysplasia (need for oxygen at 28 days) and [death or chronic lung disease (need for oxygen at 36 wks PCA)] were not significantly different: 50 vs 55% and 31.5 vs 37 % respectively. Rate of severe cerebral damage (intraventricular haemorrhage grade III/IV or cystic periventricular leukomalacia) and mortality was 9.8 % and 7.5 % during period I and II, respectively. The mortality rate was 16.3% during period I and 10 % during period II.
Conclusion: Early nCPAP, in the delivery room, in combination with early curative surfactant therapy in ELBW infants appears feasible. Neonatal short term morbidity and mortality are not affected by such strategy. Controlled prospective studies are needed to assess the benefit of such strategy
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Boubred, F., Fayol, L., Arnaud, F. et al. 37 Early Nasal Continuous Positive Airway Pressure (Ncpap) in Combination with Early Curative Surfactant Therapy in Preterm Infants Less Than 28 Weeks Ga. Pediatr Res 56, 470 (2004). https://doi.org/10.1203/00006450-200409000-00060