Mask Continuous Positive Airway Pressure in The Delivery Room Improves Outcomes of Term and Near-Term Infants With Respiratory Distress 1952

Abstract

Objective: To evaluate the effect of delivery room mask continuous positive airway pressure (mCPAP) on the outcomes of newborns with respiratory distress (RD). Design: Retrospective chart review.Setting: Tertiary perinatal center in a private community hospital. Patients: All inborn infants of gestational age (GA)>34 wks with RD at birth (persistent grunting, nasal flaring, retractions, tachypnea) who were discharged between January 1 and June 30, 1997.Interventions: Use of mCPAP, excluding bag-mask ventilation (BMV) and endotracheal intubation (ETT). Outcome measures: Admission to Neonatal Intensive Care Unit (NICU), NICU length of stay (LOS), RD duration, pneumothorax, and total LOS. Logistic regression analysis was used to compare the use of mCPAP with non-treatment. Results: A total of 1,228 charts were reviewed; 71 (5.8%) represented births at GA <35 wks, a main exclusion criterion. Of the remainder, 171 infants (14.8%) had RD in the delivery room and were the focus of this study. The Cesarean section rate of these symptomatic infants was 31.6% vs. 21.6% of all cases reviewed (p<0.01, Chi-square). Of the infants with RD at birth, 109 received mCPAP, 13 received BMV, 3 received ETT, and 53 received no ventilatory intervention(some received multiple interventions). The 15 cases who received BMV and/or ETT were excluded from analysis. The 103 infants who received only mCPAP(group 1) vs. 53 with no ventilatory intervention (group 2) did not differ statistically in birthweight, GA, Apgar scores, mode of delivery, or RD (based on a scoring system). Twenty-two (21%) of group 1 vs. 19 (36%) of group 2 were admitted to the NICU [odds ratio 0.28 (95% CI 0.09-0.82), p=0.032]. Two (1.9%) of group 1 vs. 5 (9.4%) of group 2 developed a pneumothorax [odds ratio 0.18(95% CI 0.02-1.26), p=0.036]. RD persisted for 0.55 days (SD 1.3) for group 1 vs. 1.1 days (SD 2.0) for group 2 (p=0.008). Of infants admitted to the NICU, NICU LOS was 5.3 (SD 5.2) for group 1 vs. 5.3 (SD 4.5) for group 2 (NS). Total LOS was 4.1 (SD 5.5) for group 1 vs 3.6 (SD 3.2) for group 2 (NS).Conclusions: RD is common in term and near-term infants in the delivery room. In this study, the use of mCPAP to treat infants with RD in the first minutes after birth: 1) decreased the likelihood of admission to the NICU; 2) decreased the duration of RD; and 3) may have reduced the risk of pneumothorax. NICU LOS and total LOS were not affected. These findings have major implications with respect to parent-infant separation and cost of care.