Early nasal continuous positive airway pressure compared with mechanical ventilation in very-low-birth-weight neonates

Abstract

ObjectivesTo determine whether prophylactic nasal continuous positive airway pressure (CPAP) applied soon after birth, regardless of the respiratory status, in very-low-birth-weight (VLBW) neonates reduces the use of mechanical ventilation and its hazards.BackgroundUsing nasal CPAP early in VLBW neonates is highly beneficial and associated with lower complications compared with mechanical ventilation.Patients and methodsThis prospective clinical trial was performed on 40 preterm neonates less than 37 weeks old and with body weight greater than 1000 g and less than 1500 g, who were admitted to the neonatal intensive care unit of Shibin El-Kom teaching hospital because of VLBW. Patients were randomly allocated into the following treatment groups. Group I included 20 preterm neonates supported by nasal CPAP immediately after birth regardless of their respiratory status. Group II included 20 preterm neonates receiving routine neonatal care. Survival analysis was applied to estimate and compare survival rates, the duration of oxygen therapy, and the hospital stay using the independent sample t-test.ResultsRegarding the initial and the final arterial blood gases in the CPAP group, there was a statistically significant difference with respect to the PO 2 . In contrast, there were no statistically significant differences in the initial and the final arterial blood gases in the non-CPAP group.There was a statistically significant difference between the CPAP group and the non-CPAP group with regard to the whole duration of stay in the neonatal intensive care unit (the duration was 19.60 ± 3.44 and 32.10 ± 12.28, respectively) and the whole duration of ventilation (the duration was 4.0 ± 5.32 and 24.70 ± 13.0, respectively).ConclusionThe use of nasal CPAP was associated with a lower duration of stay, a lower incidence of complications (pneumothorax, bronchopulmonary dysplasia, pulmonary hemorrhage, and sepsis), and a decreased need for mechanical ventilation.