Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

Abstract

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Delivery room CPAP in improving outcomes of preterm neonates in low-and middle-income countries: A systematic review and network meta-analysis

“…A total of 18 studies were included in the systematic review. These comprised of observational studies without a comparator arm: six studies [29][30][31][32][33][34] , observational studies with a comparator arm: five studies [35][36][37][38][39] and RCTs: seven studies [40][41][42][43][44][45][46] . Eleven (4210 neonates) out of the eighteen studies were synthesized in a meta-analysis.…”

“…Eleven (4210 neonates) out of the eighteen studies were synthesized in a meta-analysis. [35][36][37][38][40][41][42][43][44][45][46] The literature search process is given in Figure 1.…”

Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review

“…We found 25 studies exploring respiratory support in LMICs [ 150 - 173 ]. The implementation of bubble continuous positive airways pressure devices (bCPAP) has been shown to be feasible in multiple LMIC settings, in secondary and tertiary level facilities [ 151 , 153 - 156 , 160 , 163 , 166 , 170 , 171 ]. 2 recent systematic reviews have examined the impact of this on neonatal outcomes, specifically in LMICs [ 152 , 161 ].…”

Identifying Genomic Alterations in Small Cell Lung Cancer Using the Liquid Biopsy of Bronchial Washing Fluid

“…Despite significant advances in clinical treatment of non-small cell lung cancer, SCLC has been recognized as a drug development blind spot. The key to accurate oncology is the identification and detection of molecular biomarkers that can predict the diagnosis, prognosis, and curative effect (17). Therefore, one of the priorities for future clinical research on SCLC is to seek predictive markers for accurate treatment.…”