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Early nasal continuous positive airway pressure and low threshold for intubation in very preterm infants
Author(s) -
Te Pas Arjan B,
Spaans Vivian M,
Rijken Monique,
Morley Colin J,
Walther Frans J
Publication year - 2008
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2008.00867.x
Subject(s) - medicine , bronchopulmonary dysplasia , intubation , continuous positive airway pressure , anesthesia , gestational age , pregnancy , genetics , obstructive sleep apnea , biology
Aim: To determine if selective intubation, use of early nasal continuous positive airway pressure (NCPAP) at birth with a low threshold for early surfactant treatment, reduces the need for intubation in very preterm infants in the first days after birth. Methods: Two cohorts of very preterm infants ≤ 32 weeks, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (1996–1997) and after (2003–2004) introducing selective intubation and use of early NCPAP. A FiO 2 ≥ 0.40 was used as criterion for intubation. Primary outcome measure was intubation < 72 h of age. Bronchopulmonary dysplasia (BPD) was a secondary outcome. Results: The rate of intubation in the delivery room (69% vs. 46%, p < 0.001) and within 72 h of age (73% vs. 57%, p < 0.001) was lower following the change in policy. Early NCPAP was, in 2003–2004, increasingly used as primary treatment (10% vs. 33%, p < 0.001) with higher maximum NCPAP levels (4.0 (0.9) vs. 5.8 (1.5), p < 0.001). There was no change in BPD (14.3% vs. 15.2%, p = 0.82). Conclusion: Avoiding intubation by using early NCPAP while maintaining a low‐threshold for surfactant treatment decreased the need for intubation.