Pulmonary air leaks and NCPAP failure in late preterm infants with respiratory distress

Abstract

Aims: To study incidence and type of pulmonary air leak in preterm infants with respiratory distress treated with early nasal continuous positive airway pressure (NCPAP) and to assess risk factors for NCPAP-failure. Methods: A prospective, observational, single center study from August 2007 to November 2008. Early NCPAP using Infant Flow CPAP system was started in patients with a median (range) postnatal age of 1.47 (0.5-11) hours. A written NCPAP protocol including chest x-ray was applied to detect early signs of air leak. Babies were intubated when their FiO2 requirements were > 0.35. Results: 54 neonates, 45 with respiratory distress syndrome and 9 with transient tachypnea of the newborn, were studied with a gestational age of 33.6 ± 1.1 weeks and a birthweight of 2026± 303 gm (mean± SD). A total of five infants had air leak (9.3%), one of them developed pneumothorax (1.8%) and four infants had transient pulmonary interstitial emphysema (7.4%). NCPAP- failure rate was 48.1%. The single case with pneumothorax was discovered only after being intubated and surfactant was administered. Conclusion: Early NCPAP/low threshold rescue surfactant policy in preterm infants > 32 weeks of gestation with respiratory distress was associated with a 9.3% incidence of air leak, mainly in the form of pulmonary interstitial emphysema. Clinical variables significantly associated with NCPAP- failure wer e RDS and early onset sepsis.