EARLY USE OF CONTINUOUS POSITIVE AIR WAY PRESSURE FOR PREVENTION AND TREATMENT OF RESPIRATORY DISTRESS SYNDROME IN PRETERM INFANTS

Abstract

Respiratory support is the mainstay intervention for support of postnatal respiratory adaptation and treatment of preterm infants. There is no doubt today about the clinical benefits of early use of non-invasive respiratory support over traditional tracheal intubation and mechanical ventilation in the context of reducing the risk of death, lung injury, and long-term chronic morbidity. In particular, continuous positive airway pressure (CPAP) is the most commonly used method of initial non-invasive respiratory support (NRS) for spontaneously breathing preterm newborns. This method of NRS is preferred in practice because of its easy use, accessibility and effectiveness. Application of CPAP increases functional residual lung capacity and tidal volume, which is important for the prevention and treatment of respiratory distress- syndrome. However, significant proportion of preterm infants managed on CPAP require transfer to mechanical ventilation as NRS becomes ineffective ultimately. The requirement for tracheal intubationand initiation of mechanical ventilation increases the risk of complications and adverse outcomes in such infants. In particular, CPAP failure is associated with higher rate of intraventricular hemorrhages, bronchopulmonary dysplasia, and increases the risk of death. Therefore, the priority is to maximize effectiveness of CPAP application. This can be achieved by identifying a risk group, namely the infants, who have a high probability of this respiratory support type failure, and by timely adding supplementary measures that can increase the effectiveness of CPAP. This review substantiates the expediency of early CPAP use for treatment of preterm newborns, describes the risk factors of CPAP failure and ways to improve the effectiveness of this method of NRS.