Nasal continuous positive airway pressure and outcomes of preterm infants

OBJECTIVES: To document the effects of changing to a primarily nasal continuous positive airway pressure (CPAP)-based system of respiratory support on respiratory and non-respiratory outcomes in preterm infants. METHODOLOGY: Outcomes in two groups of preterm infants with a birthweight of 1000-1499 g were compared retrospectively over a 5-year period before (period I; n = 57) and after (period II; n = 59) the introduction of a primarily nasal CPAP-based approach to respiratory support, modelled closely on that used at the New York Presbyterian Hospital (Columbia University), formally known as the Columbia-Presbyterian Medical Center, in New York. RESULTS: From period I to period II, there was a decline in the number of infants ventilated (65 vs 14%, respectively) and receiving surfactant (40 vs 12%, respectively) and in the median days of ventilation (6 vs 2, respectively) and oxygen (4 vs 2, respectively). There were decreases in chronic lung disease (CLD) at 28 days (11 vs 0%, respectively), death or CLD at 28 days (16 vs 3%, respectively), the use of pressor support (34 vs 7%, respectively), the incidence of necrotizing enterocolitis (11 vs 0%, respectively), time to reach full oral feeds (17.3 vs 13.2 days, respectively), discharge weight (2569 vs 2314 g, respectively) and average length of stay (61 vs 52.9 days, respectively). There were no differences in neurosonographic or other morbidity outcomes. CONCLUSIONS: A CPAP-based approach to respiratory support of the preterm infant may decrease the invasiveness and duration of respiratory support and may decrease respiratory and some non-respiratory adverse outcomes without an associated increase in neurosonographic or other morbidity outcomes. Further prospective trials are warranted.