Nasal CPAP in newborns with birth weight under 1500 g

OBJECTIVE: To evaluate the efficacy and safety of early nasal continuous positive airway pressure (CPAP) in the pulmonary management of very low birth weight (VLBW) infants. METHOD: Since 1993 in our neonatal intensive care unit we decided to reduce the rate of tracheal intubation and mechanical ventilation (IPPV) using more extensively nasal CPAP. By Student's t test and c2 analysis, VLBW infants with gestational age < 32 weeks born in 1988-92 were compared with those born in 1993-97. RESULTS: The 144 enrolled infants were comparable for birth weight and gestational age. There was a difference in the rate of antenatal steroid administration and cesarean section delivery, significantly more used in the second period. In both groups, 93% of the infants required respiratory support. The use of IPPV decreased from 68% in the first period to 30% in the second, conversely the use of CPAP increased from 25 to 63%. With regard to the primary outcome, in the second period the mortality rate and the incidence of pneumothorax were significantly lower. CONCLUSIONS: As the long-term survival of VLBW neonates continues to improve, pulmonary management is increasingly directed at minimizing the invasivity. This study demonstrated that early nasal CPAP may be successfully used in most VLBW infants. Also in the smallest neonates the procedure is safe and effective and may be important in lowering pulmonary morbidity and subsequent mortality.