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Background Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would reduce the rate of death or bronchopulmonary dysplasia in very preterm infants.
Methods We randomly assigned 610 infants who were born at 25-to-28-weeks' gestation to CPAP or intubation and ventilation at 5 minutes after birth. We assessed outcomes at 28 days of age, at 36 weeks' gestational age, and before discharge.
Results At 36 weeks' gestational age, 33.9% of 307 infants who were assigned to receive CPAP had died or had bronchopulmonary dysplasia, as compared with 38.9% of 303 infants who were assigned to receive intubation (odds ratio favoring CPAP, 0.80; 95% confidence interval [CI], 0.58 to 1.12; P=0.19). At 28 days, there was a lower risk of death or need for oxygen therapy in the CPAP group than in the intubation group (odds ratio, 0.63; 95% CI, 0.46 to 0.88; P=0.006). There was little difference in overall mortality. In the CPAP group, 46% of infants were intubated during the first 5 days, and the use of surfactant was halved. The incidence of pneumothorax was 9% in the CPAP group, as compared with 3% in the intubation group (P<0.001). There were no other serious adverse events. The CPAP group had fewer days of ventilation.
Conclusions In infants born at 25-to-28-weeks' gestation, early nasal CPAP did not significantly reduce the rate of death or bronchopulmonary dysplasia, as compared with intubation. Even though the CPAP group had more incidences of pneumothorax, fewer infants received oxygen at 28 days, and they had fewer days of ventilation. (Australian New Zealand Clinical Trials Registry number, 12606000258550.)
Source Information
From Neonatal Services, Royal Women's Hospital (C.J.M., P.G.D., L.W.D.); the Departments of Obstetrics and Gynaecology (C.J.M., P.G.D., L.W.D.) and Pediatrics (J.B.C., L.W.D.), University of Melbourne; the Neonatal Department, Royal Children's Hospital (C.J.M.); and the Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute (J.B.C.) — all in Melbourne, Australia; the Division of Neonatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY (L.P.B.); and the Neonatal Department, Maternité Régionale, Nancy Université, Nancy, France (J.-M.H.).
Address reprint requests to Dr. Morley at Neonatal Services, Royal Women's Hospital, 132 Grattan St., Carlton, VIC 3053, Australia, or at colin.morley{at}rwh.org.au.
Related Letters:
Nasal CPAP for Very Preterm Infants
Nanan R. K.H., Liu A. J.W., Poulton A., Zanardo V., Trevisanuto D., Chiarelli S., Hughes-Davies T., Morley C. J., Davis P. G., Doyle L. W.
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N Engl J Med 2008;
358:2520-2521, Jun 5, 2008.
Correspondence
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