163 Implementation of CPAP for The Early Stabilization of VLBW Infants

Abstract

Background: The introduction of continuous positive airway pressure (CPAP) in neonatal units offers a new strategy in the early stabilization and management of the newborn, especially in very-low-birth-weight (VLBW) infants. Aims: To compare the number of VLBW infants intubated within the first 36 hours of life when CPAP was introduced for early stabilization, with another group of VLBW infants managed without the use of early CPAP. To compare in both groups of VLBW infants the frequency of pneumothorax, bronchopulmonary dysplasia (BPD), mortality, severe brain injury, length of stay and days of intubation. Methods: Study of evaluation with comparison before-after of VLBW infants born in a tertiary care hospital during two periods: Group 1: 78 VLBW infants born during 2001 and Group 2: 80 VLBW infants born from June 2003 to February 2004. In the group 1, conventional management was performed (intubation and administration of surfactant in the delivery room in <28wks or <1000g with respiratory distress syndrome). In the group 2, CPAP was introduced for early stabilization. Results: In the group 1 mean weight was 1059±309 g and in the group 2 was 1127±295 g (p= 0.15). The mean gestational age was 29±3.3 weeks in the group 1 and 29±2.8 weeks in the group 2 (p=1). There were no significant differences in intrauterine growth restrictions, CRIB and use of antenatal steroids. In the group 1 CPAP was used for early stabilization in 8,9% and in the group 2 in 48,7% (p<0,0001). Intubated in the delivery room, 54% in group 1 versus 31% in the group 2 (p=0,004). Intubated in the first 36 hours 73% versus 49% respectively (RR=1,5(1,15–1,95). Mean days of intubation were 4±11 in the group 1 and 2.7±5,8 in the group 2 (p=0,15). The mortality rate was the same (15%) in both groups. BPD at 36 weeks was 19% in the group 1 and 14.5% in the group 2 (RR=1,34 (0,63–2,84)). Mean days on oxygen were 34±47 and 21±25 respectively (p=0,04). Pneumothorax was similar in both groups (RR=1,03 (0,21– 4,95)). Severe brain injury was similar in both groups: intraventricular haemorrhage III RR=1,03 (0,15–7,10) and cystic brain lesions RR=1,03 (0,22– 4,92). The mean length of stay was 68±37 days in the group 1 and 58±25 in the group 2 (p=0,08). Conclusion: The use of CPAP for early stabilization of VLBW infants seems to be a reasonable alternative as any adverse effects has been observed, although we have not long term follow up outcomes.