Page 60 - Physiological based CPAP for preterm infants at birth Tessa Martherus

Chapter 2
Table 2. Short-term clinical outcomes
Apgar score at 5 minutes after birth a Intraventricular haemorrhage >grade 2 (%) b
Pneumothorax incidence <72h after birth (%) b Pneumothorax incidence during hospitalization (%) b Intubation rate <72h after birth (%) b
Intubation rate during hospitalization (%) b Spontaneous intestinal perforation (%) b
8 (6-9)
3 (11)
1 (4)
1 (4) 15 (56) 19 (70) 0 (0)
8 (7-8)
2 (7)
3 (11) 5 (19) 7 (26) 8 (30) 4 (15)
0.947 1.000
0.500 0.125 0.057 0.013 0.125
Low- pressure group (n=27)
High- pressure group (n=27)
P- value
Data are presented as median (IQR) and n (%), p-values are calculated by a) Related-Samples Wilcoxon Signed Rank Test and b) Related-Samples McNemar test.
Short-term clinical outcomes were comparable between the groups; only intubation rate during admission was significantly higher in the low-pressure group (70 vs. 30%, p=0.013). The pneumothorax incidence (4 vs. 19%, p=0.125) and occurrence of spontaneous intestinal (0 vs. 15%, p=0.125) perforations during admission were not significantly higher in the high-pressure group (Table 2).
Discussion
In recent years, the focus of respiratory support has shifted toward a more gentle approach (6-8) using non-invasive CPAP and PPV, and room-air or an oxygen/air blend to commence resuscitation (9-11). Still many very preterm infants are hypoxic in the first minutes after birth and take some time to reach oxygen target values (23). Since the focus has shifted toward supporting spontaneous breathing (6), the use of CPAP strategies have gained much interest, but it is still unknown as to what CPAP level is best and how this interacts with different oxygen strategies. Despite numerous clinical trials and meta- analysis, there is also still insufficient data to recommend an oxygen strategy for very preterm infants (28-30). This retrospective matched-pairs study explored two respiratory support approaches in the delivery room for very preterm infants focusing on high CPAP levels or oxygen.
During phase I of the study, the two centers used statistically different mean airway pressures and FiO2 levels. The difference in FiO2 was the least during this part of the study period. Also, at this stage of lung aeration the available surface area for gas exchange is relatively low. We therefore concluded that the FiO2 had the least clinical impact and the main treatment during this part of the study period was pressure levels. In these first minutes after birth, the different pressure levels did not affect SpO2, heart rate and SpO2/FiO2 ratio. In contrast to
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