Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants

Subramaniam, Prema; Ho, Jacqueline J; Davis, Peter G

doi:10.1002/14651858.cd001243.pub4

Cited by 42 publications

(35 citation statements)

References 48 publications

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“…CPAP applied immediately after birth in preterm infants of <33 weeks’ gestation improves survival without bronchopulmonary dysplasia. 5 This knowledge has been extrapolated to term and ≥34 +0 weeks’ gestation infants despite limited evidence. To our knowledge, this is the first systematic review and meta-analysis evaluating delivery room CPAP in this population.…”

Section: Discussionmentioning

confidence: 99%

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Continuous positive airway pressure for term and ≥34+0 weeks’ gestation newborns at birth: A systematic review

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…In preterm infants of <33 weeks’ gestation, early CPAP use decreases the need for mechanical ventilation and decreases the risk of death or chronic lung disease. 5 …”

Section: Introductionmentioning

confidence: 99%

Continuous positive airway pressure for term and ≥34+0 weeks’ gestation newborns at birth: A systematic review

et al. 2022

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“…For spontaneously breathing preterm infants, CPAP initiation rather than intubation will reduce lung injury and BPD [46]. Traditionally, this has been managed using a face mask and a CPAP level of around 5–6 cm H 2 O; however, there is no strong evidence to recommend any particular level of pressure [47].…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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“…The 2019 European Consensus Guidelines on the management of RDS recommend the early use of continuous positive airway pressure (CPAP) of at least 6 cm H 2 O in all babies at risk of RDS who do not need intubation for delivery room stabilization ( 1 ). Early initiation of CPAP potentially reduces the need for mechanical ventilation and surfactant replacement ( 2 , 3 ) while improving clinical outcomes ( 2 , 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Failure of early non-invasive ventilation in preterm infants with respiratory distress syndrome in current care practice in Spanish level-III neonatal intensive care units – a prospective observational study

et al. 2023

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IntroductionDespite advances in respiratory distress syndrome (RDS) management over the past decade, non-invasive ventilation (NIV) failure is frequent and associated with adverse outcomes. There are insufficient data on the failure of different NIV strategies currently used in clinical practice in preterm infants.MethodsThis was a prospective, multicenter, observational study of very preterm infants [gestational age (GA) <32 weeks] admitted to the neonatal intensive care unit for RDS that required NIV from the first 30 min after birth. The primary outcome was the incidence of NIV failure, defined as the need for mechanical ventilation for <72 h of life. Secondary outcomes were risk factors associated with NIV failure and complication rates.ResultsThe study included 173 preterm infants with a median GA of 28 (IQR 27–30) weeks and a median birth weight of 1,100 (IQR 800–1,333) g. The incidence of NIV failure was 15.6%. In the multivariate analysis, lower GA (OR, 0.728; 95% CI, 0.576–0.920) independently increased the risk of NIV failure. Compared to NIV success, NIV failure was associated with higher rates of unfavorable outcomes, including pneumothorax, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, and a combined outcome of moderate-to-severe bronchopulmonary dysplasia or death.ConclusionNIV failure occurred in 15.6% of the preterm neonates and was associated with adverse outcomes. The use of LISA and newer NIV modalities most likely accounts for the reduced failure rate. Gestational age remains the best predictor of NIV failure and is more reliable than the fraction of inspired oxygen during the first hour of life.

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Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants

Cited by 42 publications

References 48 publications

Continuous positive airway pressure for term and ≥34+0 weeks’ gestation newborns at birth: A systematic review

Continuous positive airway pressure for term and ≥34+0 weeks’ gestation newborns at birth: A systematic review

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Failure of early non-invasive ventilation in preterm infants with respiratory distress syndrome in current care practice in Spanish level-III neonatal intensive care units – a prospective observational study

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