Z Geburtshilfe Neonatol 2009; 213 - PO_N_10_06
DOI: 10.1055/s-0029-1223118

Sustainable use of continuous positive airway pressure in preterm infants and magnetic resonance imaging of the brain at term

B Geier, MRCPCH 1, S Langner 2, N Hosten 2, C Fusch 3
  • 1Klinik und Poliklinik für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Greifswald
  • 2Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Greifswald der Ernst-Moritz-Arndt-Universität, Greifswald
  • 3Devision of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Kanada

Aims: Early use of nasal continuous positive airway pressure (nCPAP) may be beneficial in reducing bronchopulmonary dysplasia (BPD), but how many preterm infants can be cared for without any mechanical ventilation?

Participants and Methods:

Retrospective study to evaluate the feasibility of initiating nCPAP in the delivery room and continuing this therapy without intubation [period: 2007 to 2008]. Data were collected on our very low birth weight (VLBW) infants of less then 1500 grams. They had magnetic resonance imaging (MRI) of the neonatal brain at term (37 to 42 weeks).

Results:

116 VLBW infants (range: 22+3 to 33+5 weeks; minimal birthweight: 335grams) were admitted; 54 VLBW who were born at a median gestational age of 29 (range: 25+0 to 33+5) weeks and a median birth weight of 1140 (range: 490 to 1495) grams did not affect the need for intubation at birth or during the subsequent weeks; 19 of those 54 infants had an extremely low birth weight (ELBW) of less then 1000 grams.

Of the 54 patients studied: 2 ELBW and 4 VLBW infants received endotracheal surfactant through a nasogastric feeding tube. 2 infants had pneumothoraces, 1 required a drainage. 1 infant developed mild BPD. 2 infants had retinopathy of prematurity (ROP) II° and 1 infant ROP I°.

3 infants showed intraventricular haemorrhage (IVH) I° and 1 infant IVH III° with a unilateral parenchymal lesion; 2 infants have periventricular leucomalacia, 1 infant a subdural bleeding and myelination was rarely delayed on MRI. 9 infants had no MRI but a normal neuropaediatric examination and normal ultrasound scans.

Conclusions: Approximately half of our VLBW infants did not need intubation and do well.

Literatur: Delivery room continuous positive airway pressure/positiveend-expiratory pressure in extremely low birth weight infants: a feasibility trial Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EF, Wright LL, Kandefer S, Poole WK; National Institute of Child Health and Human Development Neonatal Research Network Department of Pediatrics, University of California, 200 W Arbor Dr, 8774, San Diego, CA 92103-8774, USA. nfiner@ucsd.edu Pediatrics. 2004 Sep;114(3):651-7
Nasal CPAP or intubation at birth for very preterm infants Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB; COIN Trial Investigators N Engl J Med. 2008 Feb 14;358(7):700-8

bronchopulmonary dysplasia (BPD) - continuous positive airway pressure (CPAP) - magnetic resonance (MRI) of the brain at term - neonatology - very low birth weight (VLBW)