Standardized approach to CPAP therapy in the delivery room in full-term infants with congenital infection: observational research

Abstract

Background. At the present day, there are no protocols and guidelines on the therapeutic approaches of respiratory disorders in full-term infants in the delivery room. This concerns indications for the choice of respiratory therapy, parameters and its duration for deciding on effectiveness.The aim of the study is — to evaluate the effectiveness and safety of the standardized CPAP (continuous positive airway pressure) protocol therapy of transient tachypnea of newborns (TTN) in the delivery room in full-term infants with congenital infection.Methods. An observational clinical study of the efficacy and safety of the standardized CPAP therapy protocol developed by us for children with TTN in the delivery room in children with congenital infection, used during 6 months of 2021 in comparison with the historical control group recruited according to the same criteria for 12 months of 2020. The assessment of cerebral damage, the nature and duration of respiratory therapy and the duration of hospitalization of patients in comparison with those in the historical control group was carried out.Results. In 2020, out of 3901 full-term infants, CPAP was performed in the delivery room for 223 children, 31 of them with infection (control group). In 2021, out of 2057 full-term CPAP was performed on 140 children, 15 of them with infection (study group). A comparative analysis of the groups revealed no statistical differences in anthropometric data, gestational age, gender, APGAR score, as well as differences in the history of pregnancy and childbirth. The analysis of clinical characteristics also showed no differences between the groups (control group versus study group) in the frequency of cerebral ischemia (25 (80.6%) of the control group versus 9 (60.0%) of the study group; p = 0.135) and subependymal hemorrhage (6 (19.3%) of the control group versus 3 (20.0%) of the study group; p = 0.959), the frequency of ventilation (10 (32.2%) of the control group versus 5 (33.3%) of the study group; p = 0.942) and its duration (1 (1; 1.75) of the control group versus 2 (1.25; 2) days of the study group; p = 0.211), the frequency of BinCPAP (9 (29.3%) of the control group versus 5 (33.3%) of the study group; p = 0.434) and its duration (1 (1; 2) of the control group versus 1 (1; 1) day of the study group; p = 0.434) and the total duration of hospitalization (14 (10; 16) control groups versus 12 (12; 14) days of the study group; p = 0.429).Conclusion. The conducted study does not exclude that the standardized protocol of CPAP therapy in the delivery room for congenital infection is ineffective and does not affect the severity and duration of the disease, however, in combination with the data of the same protocol for TTN described in our previous studies, the high frequency of TTN and the low frequency of infection, the impossibility of their early differentiation allows assume, that the presented method can be considered as a universal respiratory strategy for full-term newborns with respiratory insufficiency in the delivery room.