Nasal CPAP has become an indispensable part of the primary treatment of newborns with respiratory distress syndrome

Abstract

Prenatal steroids, early nasal CPAP combined with early surfactant treatment followed by extubation to nasal CPAP, and if necessary mechanical ventilation is a very effective treatment of respiratory distress syndrome. This treatment package is part of the 'Scandinavian model' for treatment of very-low-birthweight infants which also comprises gentle ventilation at birth; minimal handling; 'neonatal individualized development care and assessment program'; high priority of breast feeding; and use of kangaroo method and which facilitates observation and nursing of sick premature infants and optimizes the possibility for early mother-child contact. The incidence of bronchopulmonary dysplasia seems to be less of a problem in centres preferring nasal CPAP as the primary treatment for respiratory distress syndrome.

Early Surfactant Guided by Lamellar Body Counts on Gastric Aspirate in Very Preterm Infants

“…Moderate to severe cases of RDS will progress if the condition is not treated. Early nasal continuous positive airway pressure (nCPAP) decreases or halts the progression so that mechanical ventilation (MV) can be avoided in many cases [1,2,3]. In addition, about half of infants with RDS treated with nCPAP need surfactant supplementation to stop the progression [4,5].…”

Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

“…Así, fue posible abordar un interrogante que ha generado controversia en los últimos años: ¿cuál es la mejor opción de tratamiento para los recién nacidos con déficit de surfactante, en quienes la opción de aplicarlo de manera suplementaria implica recurrir al soporte respiratorio con métodos invasivos o con alternativas no invasivas, pues esta conducta influye claramente en los resultados? (1,5,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

“…Estos resultados se unen a los de muchas otras series citadas en la literatura científica, en las que se ha encontrado que la CPAP disminuye la incidencia de displasia broncopulmonar (3,4,(6)(7)(8)18,19,21,24,32,33). En otros estudios no se han encontrado diferencias en la incidencia de la displasia broncopulmonar, pero en ninguno de ellos se empleó la misma intervención evaluada en el presente estudio.…”

Non-invasive respiratory support and preterm infants: The crucial role of nurse management

“…Since prolonged length of mechanical ventilation via the ET seems related to Bronchopulmonary Dysplasia (BPD) [5,6] , clinicians are increasingly using non-invasive respiratory supports to try to protect the preterm infant's lungs [7,8] . In the NICU the utilization of non invasive modality as unique respiratory support in the management of RDS has increased in the last years (see Figure 1).…”

“…Minimal handling, wrapping (see Figure 3), neonatal individualized development care/assessment program, kangaroo care and breast feeding involving mother of the preterm babies, are very important to reduce negative stimulation of the infants in NIV and to reduce the need of pharmacological pain management [8] . It has been demonstrated that iatrogenic pain is a serious problem (particularly for ELBW infants born < 28 wks) [26] with negative effects on neurological development and with the risk of agitation and of influence on cerebral hemodynamics [27] .…”