By Michelle Rizzo
New York - Results of a study hint that nasal continuous positive airway pressure (CPAP) can be used to support the breathing of extremely preterm infants soon after delivery.
The benefit of CPAP "had been doubted because in this form of support the babies have to take their own breaths and it was not clear if they could sustain this," Dr David Edwards, of Hammersmith Hospital, London, said in an interview with Reuters Health.
"The more conventional approach is to use a mechanical ventilator, which blows air into the lungs," he explained. "Unfortunately mechanical ventilation seems to damage the lungs leading to chronic lung disease and even death."
In his experience, Edwards said, CPAP "improves survival (with) less long-term lung damage in very preterm infants."
In the Archives of Disease in Childhood: Foetal and Neonatal Edition, Edwards and colleagues describe their experience with attempts at going from the ventilator to nasal CPAP in a group of infants born at less than 27 weeks' gestation. The mean birth weight was 778 grams and the mean gestational age was 25,3 weeks.
Of 53 infants on ventilators, extubation was attempted in 21 on day 1 and was successful in 14. On day 2, extubation was attempted in 15 of 35 infants, and was successful in 12. Five infants died within 48 hours.
By day 7, a total of 30 of the 43 surviving infants were on nasal CPAP.
The investigators report that five of 23 infants who were on mechanical ventilation at 48 hours of age were on air at 36 weeks' postmenstrual age and 11 had died. Among 26 infants on CPAP at 48 hours, 12 were on air at 36 weeks' postmenstrual age while three had died.
The probability of an infant remaining on CPAP on day one was 66 percent and on day two was 80 percent.
Based on these promising results, the researchers call for further studies of the use and value of CPAP in extremely preterm infants soon after delivery.
SOURCE: Archives of Disease in Childhood: Foetal and Neonatal Edition, November 2006.