Page 131 - Physiological based CPAP for preterm infants at birth Tessa Martherus

Feasibility and effect of physiological based CPAP in preterm infants at birth Table 3. Short-term clinical outcomes
Pneumothorax <5 days after birth (%) Intubation <24h after birth (%) Surfactant administration (%) Pulmonary hemorrhages (%) Spontaneous intestinal perforations (%) Intraventricular hemorrhages
All grades (%)
≥ grade III (%) Neonatal mortality (%)
Combined outcome intraventricular
PB-CPAP
5-8 cmH2O CPAP
P-value
(n=8) (n=20)
0 (0%) 1 (5%) 1.000
1 (13%) 2 (25%) 0 (0%) 0 (0%)
4 (50%) 2 (25%) 1 (13%) 2 (25%)
5 (25%) 10 (50%) 0 (0%)
0 (0%)
5 (25%) 1 (5%) 4 (20%) 4 (20%)
0.640 0.401 1.000 1.000
0.371 0.188 1.000 1.000
P
hemorrhages ≥ grade III and/or death (%)
Categorical data presented as n, (%) compared using a Fisher’s exact test. When not specified, outcomes are reported at NICU discharge.
Short-term clinical outcomes (Table 3)
There were no differences in short-term neonatal respiratory outcomes including incidences
of pneumothorax <5 days, intubation <24 hours, surfactant administration or pulmonary hemorrhages. Groups showed no statistical significance regarding the incidences of 5 spontaneous intestinal perforations, IVH and/or neonatal mortality.
Discussion
This study was the first to evaluate the feasibility and the direct effect of PB-CPAP for preterm infants in the DR. The study was halted prematurely due to low inclusion rates and recent changes in our local guideline that conflicted with the study protocol. Although the protocol adherence was high, evaluations by caregivers after the trial indicated that the current PB-CPAP approach is feasible in a research setting but requires simplification as discussed below. Although PB-CPAP did not improve oxygenation, it seemed beneficial for preterm infants as they showed increased heart rate and shortened duration of mask ventilation which reflects a faster and/or improved lung aeration.
The feasibility of our current PB-CPAP approach was evaluated by protocol adherence and post-trial evaluations. There were three minor protocol deviations in the PB-CPAP group, despite the presence of a dedicated person present in the DR who focussed on CPAP support. Post-trial evaluations showed that the current approach is too complex. Although routine use of PB-CPAP will likely improve dexterity and the sense of competence among caregivers, the approach requires simplification which can be achieved in various manners. First, the escape strategy (consistent 8 cmH2O CPAP) seems redundant and could be removed. The condition
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