Duration Of Respiratory Distress Research Articles

Effect of inhaled budesonide therapy in term newborns with meconium aspiration syndrome

Background: Meconium aspiration syndrome is a common cause of respiratory distress in neonates. This study explores the possibility of altering the course of the disease by using anti-inflammatory agents to counter the chemical and inflammatory pneumonitis caused by meconium. The objective is to determine if inhaled budesonide therapy can alter the clinical course of the disease and improve outcome without causing any serious adverse effects. Methods: A comparative study was conducted in NICU of Cheluvamba hospital, Mysore over 12 months. Neonates with MAS were divided into interventional and control groups. Interventional group received budesonide nebulization 12th hourly starting after 6 hours of life, while control group received saline nebulization 12 hourly. Data was analysed by SPSS 20 software and student t test and chi square test were used to assess statistical significance. Results: The patient profile of the two groups was similar, with the interventional group showing early normalization of Downes score compared to controls. The duration of respiratory distress, oxygen dependency, and duration of hospital stay was significantly less in the steroid treated group compared to controls. There was no significant difference in the incidence of sepsis between the two groups, and three patients died during hospital stay due to pneumothorax with overwhelming sepsis with DIC. Conclusions: Nebulized budesonide improves clinical outcome in terms of morbidity and is relatively safe, however long term follow up required to recommend inhalational steroids as safe and effective.

Comparison of Effects of Salbutamol Inhalation with Continuous Positive Airway Pressure and Bubble Continuous Positive Airway Pressure Alone in the Management of Severe Transient Tachypnea of the Newborn

Objective: To find the frequency of known risk factors in cases of severe transient tachypnea of the newborn (TTN) and to measure the effect of inhaled Salbutamol to bubble CPAP on required treatment duration.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Jun 2020.
 Methodology: A total of 60 cases of severe TTN, labelled on a predefined criterion were included in the study. The sample was randomized into two groups using an alternate sampling technique. Group-A was treated with bubble CPAP alone, while in Group-B, inhaled Salbutamol was added. The response was measured regarding the time taken to settle respiratory distress.
 Results: Out of 60 cases, 54(90.0%) were delivered through Caesarean section. A total of 9(15.0%) cases were born prematurely. Polycythemia was found in 10(16.6%) cases. Maternal asthma and gestational diabetes frequency were 8(13.33%) and 12(20.0%), respectively. A significant reduction was seen in the duration of respiratory distress in the study population receiving bubble CPAP with inhaled Salbutamol in the first 24 hours of illness (p-value<0.001).
 Conclusion: Caesarean section is the most significant risk factor for developing TTN. Adding Salbutamol nebulization to bubble CPAP resulted in an earlier settlement of respiratory distress.

Role of budesonide inhalation in treatment of meconium-aspiration syndrome

Background and aim Meconium-aspiration syndrome (MAS) is a common cause of respiratory distress. MAS is a serious disease that affects neonates born through meconium-stained amniotic fluid. The pathophysiology of MAS is multifactorial, inflammation has an important role in MAS, so anti-inflammatory drugs like corticosteroids may be effective in the treatment of MAS. Budesonide is a nonhalogenated glucocorticoid that can reduce vascular permeability, inhibit secretion of mucus, relieve edema and spasm, and help pulmonary ventilation. In this study we aimed to find out the effect of early nebulized budesonide in the treatment of MAS. Patients and methods This was a prospective study conducted during the period from October 2017 to July 2018 at El-Minia General Hospital and Al-Azhar University Hospital, Assiut. Intervention: budesonide inhalation in a dose of 50 mg every 12 h till clinical recovery, whichever was earlier. Results The present study revealed that nebulized budesonide improves the clinical outcome of newborns with MAS in terms of lowering the duration of O2 dependency, duration of respiratory distress, duration of hospital stay, duration of radiograph clearance, time for full feeding (P<0.001), and thus early discharge from the NICU. Conclusion Early nebulized budesonide is effective in treating MAS and has high safety with almost no short-term complications.

Association Between Intravenous Magnesium Therapy in the Emergency Department and Subsequent Hospitalization Among Pediatric Patients With Refractory Acute Asthma

Despite guidelines recommending administration of intravenous (IV) magnesium sulfate for refractory pediatric asthma, the number of asthma-related hospitalizations has remained stable, and IV magnesium therapy is independently associated with hospitalization. To examine the association between IV magnesium therapy administered in the emergency department (ED) and subsequent hospitalization among pediatric patients with refractory acute asthma after adjustment for patient-level variables. This post hoc secondary analysis of a double-blind randomized clinical trial of children with acute asthma treated from September 26, 2011, to November 19, 2019, at 7 Canadian tertiary care pediatric EDs was conducted between September and November 2020. In the randomized clinical trial, 816 otherwise healthy children aged 2 to 17 years with Pediatric Respiratory Assessment Measure (PRAM) scores of 5 points or higher after initial therapy with systemic corticosteroids and inhaled albuterol with ipratropium bromide were randomly assigned to 3 nebulized treatments of albuterol plus either magnesium sulfate or 5.5% saline placebo. Intravenous magnesium sulfate therapy (40-75 mg/kg). The association between IV magnesium therapy in the ED and subsequent hospitalization for asthma was assessed using multivariable logistic regression analysis. Analyses were adjusted for year epoch at enrollment, receipt of IV magnesium, PRAM score after initial therapy and at ED disposition, age, sex, duration of respiratory distress, previous intensive care unit admission for asthma, hospitalizations for asthma within the past year, atopy, and receipt of oral corticosteroids within 48 hours before arrival in the ED, nebulized magnesium, and additional albuterol after inhaled magnesium or placebo, with site as a random effect. Among the 816 participants, the median age was 5 years (interquartile range, 3-7 years), 517 (63.4%) were boys, and 364 (44.6%) were hospitalized. A total of 215 children (26.3%) received IV magnesium, and 190 (88.4%) of these children were hospitalized compared with 174 of 601 children (29.0%) who did not receive IV magnesium. Multivariable factors associated with hospitalization were IV magnesium receipt from 2011 to 2016 (odds ratio [OR], 22.67; 95% CI, 6.26-82.06; P < .001) and from 2017 to 2019 (OR, 4.19; 95% CI, 1.99-8.86; P < .001), use of additional albuterol (OR, 5.94; 95% CI, 3.52-10.01; P < .001), and increase in PRAM score at disposition (per 1-U increase: OR, 2.24; 95% CI, 1.89-2.65; P < .001). In children with a disposition PRAM score of 3 or lower, receipt of IV magnesium therapy was associated with hospitalization (OR, 8.52; 95% CI, 2.96-24.41; P < .001). After adjustment for patient-level characteristics, receipt of IV magnesium therapy after initial asthma treatment in the ED was associated with subsequent hospitalization. This association also existed among children with mild asthma at ED disposition. Evidence of a benefit of IV magnesium regarding hospitalization may clarify its use in the treatment of refractory pediatric asthma. ClinicalTrials.gov: NCT01429415.

Study on etiological profile of respiratory distress in new borns in a teaching hospital

Background: The aim is to study the various risk factors associated with development of severe respiratory distress in the new born.Methods: This was a prospective study of 200 new-borns with respiratory distress. Clinical details, etiology for the respiratory distress, system-wise factors responsible for the distress, severity and duration of respiratory distress, oxygen therapy, type of treatment, mortality, maternal and antenatal risk factors, radiological findings were noted in all the cases and were analysed.Results: Of the 200 cases with respiratory distress, 118 (59%) had severe respiratory distress. 154 cases with distress were of respiratory system in origin out of which 45% (70 out of 154) were due to Meconium aspiration syndrome, 42% (64 out of 154) were due to Respiratory distress syndrome, 12% (18 out of 154) were due to transient tachypnea of new-born and 2% were due to congenital pneumonia. More number of female patients had severe respiratory distress. Mortality was 2.5%.Conclusions: Meconium aspiration syndrome is the most common cause of respiratory distress in new born. Almost 60% of new borns with respiratory distress developed severe respiratory distress who required intensive monitoring. Risk factors like meconium stained liquor, vaginal delivered new borns, preterm gestation age, and female gender of new born were associated with severe respiratory distress in new borns.

Alcohol withdrawal in epileptic rats - Effects on postictal depression, respiration, and death.

Patients with epilepsy are at risk of sudden unexpected death in epilepsy (SUDEP). The most common series of events in witnessed cases of SUDEP is a generalized convulsive seizure followed by terminal apnea. Risk factors for SUDEP include prolonged postictal depression (PID), as well as alcohol abuse. The present study examined these issues in a genetic epilepsy model that exhibits generalized convulsive audiogenic seizures (AGSz) but rarely exhibits seizure-induced death, the genetically epilepsy-prone rats (GEPR-9s). We evaluated the effect of ethanol withdrawal (ETX) in GEPR-9s on respiration patterns, duration of PID, and the incidence of seizure-induced death. Audiogenic seizures were induced in GEPR-9s and in normal Sprague-Dawley rats, which were subjected to a 4-day binge ethanol protocol, 18-24h after the last ethanol dose. Following the tonic seizures, all GEPR-9s exhibited PID, characterized by loss of the righting reflex and respiratory distress (RD), which were absent during ETX seizures in the normal rats. During ETX, GEPR-9s exhibited significant increases in the duration of PID and RD, compared with vehicle-treated GEPR-9s. A significant increase in the incidence of death following seizure in GEPR-9s subjected to ETX was observed, compared with that in vehicle-treated GEPR-9s and normal rats subjected to ETX. Death in GEPR-9s was preceded by prolonged seizures because, in part, of the emergence of post-tonic generalized clonus. These results indicate that ETX induced significant increases in the duration of PID and RD, which contributed to the greater incidence of mortality in GEPR-9s compared with that in vehicle-treated GEPR-9s and normal rats. These experiments observed an elevated risk of sudden death associated with alcohol withdrawal in a genetic epilepsy model that had previously been identified as a risk factor in human SUDEP.

Endotracheal suction in term non vigorous meconium stained neonates—A pilot study

AimTo evaluate the effect of ‘No endotracheal suction’ on occurrence of meconium aspiration syndrome (MAS) and/or all-cause mortality in non-vigorous neonates born through meconium stained amniotic fluid (MSAF). MethodsThis pilot randomized controlled trial enrolled term non-vigorous neonates (≥37 weeks) born through MSAF. Neonates randomized to ‘No Endotracheal suction group’ (‘No ET’ Group; n=88) did not undergo endotracheal suction before the definitive steps of resuscitation. Neonates randomized to ‘Endotracheal suction group’ (‘ET’ Group; n=87) underwent tracheal suction as part of the initial steps as per the current NRP recommendations. The primary outcome was occurrence of MAS and/or death. Secondary outcome variables were duration and severity of respiratory distress, need for respiratory support, development of hypoxic ischemic encephalopathy (HIE) and duration of oxygen therapy and hospitalization. ResultsBaseline characters including birth weight and gestational age were similar between the two groups. MAS was present in 23 (26.1%) vs. 28 (32.2%) neonates in ‘No ET’ and ‘ET’ groups respectively (OR 0.4 (0.12–1.4); p=0.14) with 4 (4.6%) and 9 (10.34%) deaths amongst these neonates with MAS in respective groups (OR 0.75 (0.62–1.2); p=0.38). Other parameters like severity and duration of respiratory distress, need for respiratory support, incidence of HIE, duration of oxygen therapy and duration of hospitalization were comparable. ConclusionThis study demonstrates that it is feasible to randomize non-vigorous infants born through meconium stained liquor to receive on not receive endotracheal suction. There is a need for a multi-center trial to address whether the current practices and guidelines can be justified.

Respiratory Distress Following Cleft Palate Repair in Children With Robin Sequence.

Objective The aim of this study is to assess prevalence, severity, and duration of respiratory distress following palatoplasty in children with Robin sequence and to evaluate perioperative management. Design Retrospective chart review study. Data were collected for patients who were born between 2009 and 2012 and underwent palatoplasty in the Sophia Children's Hospital-Erasmus Medical Center. Results Of the 75 patients with cleft palate, 30 with Robin sequence and a control group of 45 cleft without Robin sequence underwent palatoplasty. Prior to closure, 26 of 30 patients with Robin sequence had been treated by prone positioning, and four needed additional treatment. The mean age at closure was 12.4 months for patients with Robin sequence and 10.9 months for patients without Robin sequence (P = .05). On the basis of the results of preoperative polysomnography with palatal plate, closure was postponed in two patients with Robin sequence. In the Robin sequence group, eight of the 30 patients developed postoperative respiratory distress within 48 hours and one patient, after 7 days; whereas none within the non-Robin sequence group developed respiratory distress. In all nine cases of Robin sequence the obstructive problems resolved within a few days, with four children requiring a temporary nasopharyngeal tube (NPT). There were no significant differences between preoperative polysomnography results of the nine patients with Robin sequence who developed postoperative respiratory distress compared with those patients with Robin sequence who did not. Conclusion Despite delayed closure compared with children without Robin sequence, 30% of the children with Robin sequence developed respiratory distress following palatoplasty, which resolved within a few days. This study emphasizes the need for close perioperative monitoring of patients with Robin sequence who undergo palatoplasty.

Inhibition of adenosine metabolism induces changes in post-ictal depression, respiration, and mortality in genetically epilepsy prone rats

A major cause of mortality in epilepsy patients is sudden unexpected death in epilepsy (SUDEP). Post-ictal respiratory dysfunction following generalized convulsive seizures is most commonly observed in witnessed cases of human SUDEP. DBA mouse models of SUDEP are induced by audiogenic seizures (AGSz) and show high incidences of seizure-induced death due to respiratory depression. The relatively low incidence of human SUDEP suggests that it may be useful to examine seizure-associated death in an AGSz model that rarely exhibits sudden death, such as genetically epilepsy-prone rats (GEPR-9s). Adenosine is released extensively during seizures and depresses respiration, which may contribute to seizure-induced death. The present study examined the effects of inhibiting adenosine metabolism on the durations of post-ictal depression (PID) and respiratory distress (RD), changes in blood oxygen saturation (% SpO2), and the incidence of post-seizure mortality in GEPR-9s. Systemic administration of adenosine metabolism inhibitors, erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA, 30mg/kg) with 5-Iodotubericidin (5-ITU, 3mg/kg) in GEPR-9s resulted in significant changes in the duration of AGSz-induced PID as compared to vehicle in both genders. These agents also significantly increased the duration of post-seizure RD and significantly decreased the mean% SpO2 after AGSz, as compared to vehicle but only in females. Subsequently, we observed that the incidences of death in both genders 12–48h post-seizure were significantly greater in drug vs. vehicle treatment. The incidence of death in females was also significantly higher than in males, which is consistent with the elevated seizure sensitivity of female GEPR-9s developmentally. These results support a potentially important role of elevated adenosine levels following generalized seizures in the increased incidence of death in GEPR-9s induced by adenosine metabolism inhibitors. These findings may also be relevant to human SUDEP, in light of the elevated adenosine levels that occur post-ictally in humans and its respiratory depressant actions.

Effect Of Nebulized Budesonide In Improving The Clinical Outcome Of Neonates With Meconium Aspiration Syndrome

Aim and Objective: To study the effect of nebulized steroid in improving the clinical outcome in terms of morbidity and mortality in neonates with meconium aspiration syndrome. Patients: Full term babies with clinical diagnosis of Meconium aspiration syndrome(MAS) admitted in the NICU of cheluvamba hospital attached to Mysore medical college and research institute were included in the study. Intervention: Administration of nebulized budesonide(Budecort,Cipla) in a dose of 50µg in 2.5ml normal saline through jet nebulizer every 12hourly from second day of life till 7days or clinical recovery whichever is earlier. Results: 40 patients were randomized into 20 in control group(Group-A) and 20 in budesonide group(Group-B). The baseline clinical profile of both the groups were similar. Duration of respiratory distress in days (2.63vs5.24 p=0.0493), duration of oxygen dependency(2.37vs4.94 p=0.0406), duration of hospital stay(7.58vs10.47 p=0.0430), time taken for achievement of full feeds(3.79vs8.76 p=0.0002) and the need for mechanical ventilation(0vs0.2 p=0.0356) were statistically less in budesonide treated group as compared to the controls. Complications were similar in both the groups. Four patients died during the hospital stay, three in the control group and one in the case group. Out of them, two patients died due to pneumothorax and both of them belong to the control group, other two patients died due to sepsis with disseminated intravascular coagulation(DIC), representing one each from control and case group. Conclusion:Nebulized budesonide improves the short term respiratory outcome and is relatively safe, however long term follow-up is needed to recommend inhalation route of steroids as safe and effective.

Less Invasive Unilateral Arytenoid Lateralization: A Modified Technique for Treatment of Idiopathic Laryngeal Paralysis in Dogs: Technique Description and Outcome

To (1) describe a modification of conventional unilateral cricoarytenoid lateralization (UCAL), called less-invasive unilateral cricoarytenoid lateralization (LI-UCAL) for treatment of idiopathic laryngeal paralysis (LP); (2) report clinical outcome of LI-UCAL; and (3) describe the effect of early discharge after surgery. Retrospective clinical study. Dogs (n = 22). Medical records (January 2009 to October 2011) of dogs diagnosed with idiopathic LP that had LI-UCAL were reviewed. Signalment, clinical signs, laboratory tests, imaging, concurrent medical conditions, information from the anesthesia record, and hospitalization time were documented. Follow-up was obtained by direct examination, questionnaire, and review of medical records from referring veterinarians. Dogs included in the study had variable degrees and duration of respiratory distress before surgery. Median surgery time was 32 minutes. Median hospitalization was 6 hours, and median follow-up was 427 days. Long-term respiratory function, as reported by owners at last follow-up, improved in 95.5% of dogs after surgery; exercise tolerance improved by 90%. Major complications included death secondary to aspiration pneumonia (9%), aspiration pneumonia from which dogs recovered within 3 days after administration of antimicrobials (9%), and development of right-sided laryngeal collapse that required right sided LI-UCAL (4.5%). At long-term follow-up, 95.5% of owners were satisfied with the surgical outcome. LI-UCAL is a feasible surgical technique and resulted in improvement of clinical signs related to LP. Calm recoveries without adverse effects such as respiratory distress were associated with early discharge. LI-UCAL could be considered an alternative to conventional UCAL.

Serum Interleukin-6 Levels In Differential Diagnosis Of Sepsis And Transient Tachypnea Of Newborn

Objectives: The aim of this study was to evaluate the role of serum interleukin-6 (IL-6) levels in the differentiation of neonatal bacterial sepsis and TTN. Patients and Methods: The hospital records of 58 newborns with respiratory distress that were above 35 weeks of gestational age were investigated. Patients were divided into two groups. The infection group consisted of patients with proven sepsis and clinical sepsis and the remaining one was TTN group. Clinical findings and white blood cell count, serum C-reactive protein (CRP), IL-6 levels and the ratio of immature neutrophils to total neutrophils count (I/T) were recorded and were compared between the two groups. Results: Serum CRP and IL-6 levels were found higher than normal limits in both of the groups. However there was no significant difference between them. Duration of respiratory distress was longer and I/T ratio was significantly higher in the infection group than TTN group. Conclusion: I/T ratio and IL-6 may contribute to the early diagnosis of sepsis with respiratory symptoms in newborn but IL-6 alone can not distinguish TTN and sepsis. Amac: Bu calismanin amaci yenidoganlarda serum interlokin 6 duzeyinin bakteriyel sepsis ve yenidoganin gecici takipnesinin ayriminda rolunun arastirilmasidir. Hastalar ve Yontemler: Solunum sikintisi olan ve gestasyonel yasi 35 haftadan buyuk olan 58 yenidogan calismaya alindi. Hastalar, kanitlanmis veya klinik sepsisi olanlar ve yenidoganin gecici takipnesi olanlar olmak uzere iki gruba ayrildi. Klinik bulgular beyaz kure sayisi, C reaktif protein, serum IL-6 duzeyi, periferik yaymada immature notrofil sayisinin toplam notrofil sayisina orani kaydedilerek gruplar arasinda karsilastirildi. Bulgular: Her iki grupta da serum CRP ve IL-6 duzeyleri normal limitlerden yuksek bulunmasina ragmen iki grup arasinda fark yoktu. Solunum sikintisinin suresi ve I/T orani yenidoganin gecici takipnesi olan grupta belirgin olarak fazla bulundu. Sonuc: IL-6 ve I/T orani solunum sikintisi olan sepsisli yenidoganlarin erken tanisi konusunda katkida bulunurken IL-6 duzeyi tek basina yenidoganlarda sepsis ve yenidoganin gecici takipnesinde kullanilamaz.

Cefuroxime vs a Dicloxacillin/Chloramphenicol Combination for the Treatment of Parapneumonic Pleural Effusion and Empyema in Children

The aim of this study was to evaluate the efficacy of cefuroxime, compared with the combination of dicloxacillin/chloramphenicol, for the treatment of children with parapneumonic pleural effusion or empyema. Forty patients, aged 3 months to 5 years, with pleural effusion or empyema were randomized to receive cefuroxime (100mg/kg/day) IV (n=20) or chloramphenicol (100mg/kg/day) plus dicloxacillin (200mg/kg/day) IV (n=20). Both groups were similar in age, days of illness, clinical and radiological findings, and etiology. Most patients (70%) had an empyema at presentation. There was no difference in clinical outcomes, including days to defervescence, duration of respiratory distress, duration of chest tube drainage, and days to discharge from hospital. The complication rates were similar in both groups. Pleural thickening occurred in four patients, bronchopleural fistula in two, and loculated empyema in one patient of each treatment group. Adverse effects attributed to cefuroxime were mild and infrequent. These results suggest that cefuroxime is an effective and well-tolerated alternative for the treatment of children with pleural effusion and empyema.

Immunohistochemistry of pulmonary surfactant apoprotein A in forensic autopsy: reassessment in relation to the causes of death

To reassess the immunohistochemical distribution of pulmonary surfactant apoprotein A (SP-A) in relation to the causes of death, 282 forensic autopsy cases were reviewed. The most intense and dense granular immunostaining of intra-alveolar SP-A was observed in the hyaline membrane syndrome from various traumas, protracted death from drowning, and perinatal aspiration of amniotic fluid. Similar granular staining pattern was found in fatal poisoning by a muscle relaxant and organophosphate pesticides. An evident increase of intra-alveolar granular staining was noted in most fatalities from mechanical asphyxia and drowning, and some cases of fire death. SP-A staining was usually very weak or sparse in alcohol intoxication, poisoning by hypnotics and also carbon monoxide poisoning. These findings suggest that the amount of intra-alveolar granular SP-A staining may be a possible indicator of severity and duration of respiratory distress (agony) from peripheral (non-central nervous system) origin and alveolar damage.

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

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.