Early INSURE Therapy Reduces CPAP Failure in Late Preterm Newborns with Respiratory Distress Syndrome

Olave, Maria C.; Gómez‐Ochoa, Sergio Alejandro; Jerez-Torra, Kihara Alejandra; Martínez-González, Paula Liseth; Sarmiento-Villamizar, Diego Felipe; Díaz‐Martínez, Luis Alfonso; Africano-León, Martha Lucía; Rojas-Devia, Mario Augusto; Pérez-Vera, Luis Alfonso

doi:10.14295/rp.v54i1.233

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…In our analysis, we observed low rates of surfactant use in the delivery room. Early INSURE therapy has been shown to reduce the rate of CPAP failure in infants born at 33 to 36 + 6/7 WG [ 20 ]. In the same way, less invasive surfactant administration (LISA) has been shown to prevent early CPAP failure, even if most of the infants included were < 32 WG [ 21 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants

Tourneux,

Debillon,

Flamant

et al. 2023

Eur J Pediatr

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To determine the early factors associated with continuous positive airway pressure (CPAP) failure in moderate-to-late preterm infants (32 + 0/7 to 36 + 6/7 weeks’ gestation) from the NEOBS cohort study. The NEOBS study was a multi-center, prospective, observational study in 46 neonatal intensive care units in France, which included preterm and late preterm infants with early neonatal respiratory distress. This analysis included a subset of the NEOBS population who had respiratory distress and required ventilatory support with CPAP within the first 24 h of life. CPAP failure was defined as the need for tracheal intubation within 72 h of CPAP initiation. Maternal and neonatal clinical parameters in the delivery room and clinical data at 3 h of life were analyzed. CPAP failure occurred in 45/375 infants (12%), and compared with infants with CPAP success, they were mostly singletons (82.2% vs. 62.1%; p < 0.01), had a lower Apgar score at 10 min of life (9.1 ± 1.3 vs. 9.6 ± 0.8; p = 0.02), and required a higher fraction of inspired oxygen (FiO2; 34.4 ± 15.9% vs. 22.8 ± 4.1%; p < 0.0001) and a higher FiO2*positive end-expiratory pressure (PEEP) (1.8 ± 0.9 vs. 1.1 ± 0.3; p < 0.0001) at 3 h. FiO2 value of 0.23 (R2 = 0.73) and FiO2*PEEP of 1.50 (R2 = 0.75) best predicted CPAP failure. The risk of respiratory distress and early CPAP failure decreased 0.7 times per 1-week increase in gestational age and increased 1.7 times with every one-point decrease in Apgar score at 10 min and 19 times with FiO2*PEEP > 1.50 (vs. ≤ 1.50) at 3 h (R2 of the overall model = 0.83). Conclusion: In moderate-to-late preterm infants, the combination of singleton pregnancy, lower Apgar score at 10 min, and FiO2*PEEP > 1.50 at 3 h can predict early CPAP failure with increased accuracy. What is Known: •Respiratory distress syndrome (RSD) represents an unmet medical need in moderate-to-late preterm births and is commonly treated with continuous positive airway pressure (CPAP) to reduce mortality and the need for additional ventilatory support. • Optimal management of RSD is yet to be established, with several studies suggesting that identification of predictive factors for CPAP failure can aid in the prompt treatment of infants likely to experience this failure. What is New: •Secondary analysis of the observational NEOBS study indicated that oxygen requirements during CPAP therapy, especially the product of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP), are important factors associated with early CPAP failure in moderate-to-late term preterm infants. •The combination of a singleton pregnancy, low Apgar score at 10 minutes, and high FiO2*PEEP at 3 hours can predict early CPAP failure with increased accuracy, highlighting important areas for future research into the prevention of CPAP failure.

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Section: Discussionmentioning

confidence: 99%

Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants

Tourneux,

Debillon,

Flamant

et al. 2023

Eur J Pediatr

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“…The results of the present study from 121 preterm infants aged 28 -36 weeks who experienced respiratory distress using NCPAP showed that 36 neonates had respiratory failure (29.7%) with an estimated time of respiratory failure of 60.5 hours. A study by Maria reported that among 57 preterm neonates less than 36 weeks of gestation with respiratory distress receiving (18). Another cohort study showed that among 150 preterm neonates with less than 37 weeks of gestation with respiratory distress receiving NCPAP, 37.8% experienced NCPAP failure in the first 72 hours (16).…”

Section: Discussionmentioning

confidence: 99%

Downes Score as a Predictor of Nasal Continuous Positive Airway Pressure Failure in Neonates of 28 - 36 Weeks Gestation with Respiratory Distress: A Survival Analysis

Yuniati,

Permatagalih,

Suryaningrat

et al. 2023

Iran J Pediatr

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Background: Respiratory distress is the most often encountered problem in preterm infants and the most frequently encountered reason for neonatal intensive care unit (NICU) admission. It can develop into respiratory failure and cause high morbidity and mortality. Noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), was the first line for neonates with respiratory distress. The progression of respiratory distress to respiratory failure in neonates with NCPAP (NCPAP failure) increases the need for mechanical ventilation on the first day of life. With limited resources, clinical observation is critical to predict prognosis and golden time for referral. Downes scores are the accurate and easiest measurement that is used to determine the severity and monitoring of respiratory distress in neonates. However, in Indonesia, there has still been no study that showed an effect of the increment of Downes score in 24 hours and the risk of NCPAP failure. Objectives: This study aimed to measure the association of Downes score at birth, ages 2, 6, 12, and 24 hours, and the risk of NCPAP failure in the first 72 hours using survival analysis. Methods: This prospective observational cohort study included all neonates with 28 - 36 weeks gestation born at Hasan Sadikin General Hospital, Bandung, Indonesia, within March to May 2019, with respiratory distress and NCPAP as respiratory support. Clinical monitoring was conducted using Downes score at birth, 2, 6, 12, and 24 hours of age. The time of NCPAP failure in the first 72 hours was also obtained. Survival analysis with Kaplan-Meier and Cox regression was used to determine the association. Results: This study analyzed 121 neonates at 72 hours with an overall survival rate of 70.2% and a mean survival time of 61.1 hours. Neonates born 28 < 32 weeks and birth weight 1000 - 1499 g had the lowest survival (54.5% and 56.9%). Downes score ≥ 4 at birth and 2 and 6 hours had lower survival than Downes score < 4 (67.7%, 60.5%, and 52.7%). The risk of NCPAP failure in 72 hours was increased with a higher Downes score at 2 hours (hazard ratio [HR] = 1.86 [95% confidence interval [CI]: 1.3 - 2.6, P < 0.001), 6 hours (HR = 1.67 [95% CI: 1.2 - 2.2], P < 0.001). Downes score ≥ 4 at 2 hours (3.26 times, P = 0.030) and 6 hours (2.44 times, P = 0.014) had a high risk of NCPAP failure in 72 hours. Conclusions: The increase in Downes score was associated with a high risk of NCPAP failure at 72 hours of age in preterm neonates with respiratory distress. Two to six hours of monitoring of the Downes score should be considered a critical time for referral.

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Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review

Tochie,

Sibetcheu,

Arrey-Ebot

et al. 2023

Eur J Pediatr

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Early INSURE Therapy Reduces CPAP Failure in Late Preterm Newborns with Respiratory Distress Syndrome

Cited by 4 publications

References 19 publications

Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants

Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants

Downes Score as a Predictor of Nasal Continuous Positive Airway Pressure Failure in Neonates of 28 - 36 Weeks Gestation with Respiratory Distress: A Survival Analysis

Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review

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