Kinder- und Jugendmedizin 2010; 10(01): 03-08
DOI: 10.1055/s-0038-1629000
Neonatologie
Schattauer GmbH

Nasaler CPAP als initiale Atemhilfe bei Frühgeborenen im Kreißsaal

Nasal CPAP as initial respiratory care in preterm infants in the delivery room
W. Lindner
1   Universitätsklinik für Kinder- und Jugendmedizin Ulm
,
H. Fuchs
1   Universitätsklinik für Kinder- und Jugendmedizin Ulm
› Author Affiliations
Further Information

Publication History

Eingegangen am: 15 June 2009

angenommen am: 20 July 2009

Publication Date:
25 January 2018 (online)

Zusammenfassung

Nasaler CPAP bei der respiratorischen Erstversorgung von Frühgeborenen wurde kürzlich durch eine randomisierte und kontrollierte Studie untersucht. Deren Ergebnisse stützen die Hypothese, dass FG ≥25 SSW initial mit nasalem CPAP behandelt werden können und Surfactant erst dann erhalten sollen, wenn Intubation und Beatmung erforderlich sind. Weitere Strategien zur Verbesserung der Wirksamkeit von CPAP-Therapie sind publiziert, aber noch unzureichend evaluiert. In abseh-barer Zeit werden zusätzliche Daten zur Verfügung stehen, die die zentrale Frage 舘Intubation und prophylaktischer Surfactant oder nasaler CPAP mit oder ohne Surfactant’ mit hohem Evidenzlevel beantworten werden.

Summary

Nasal CPAP as initial respiratory care in the delivery room is evaluated by one randomized controlled trial. The results suggest that it is possible to initiate CPAP in infants of 25–28 weeks’ gestation and treat them with surfactant only if they require ventilation. Additional strategies might improve the results of nasal CPAP but more information on the pros and cons of these methods are necessary. Very soon, more evidence based data will be available to answer the question ‘intubation and surfactant or nasal CPAP with or without surfactant’ with an evidence level I.

 
  • Literatur

  • 1 Aly H, Massaro AN, Patel K. et al. Is it safer to intubate premature infants in the delivery room?. Pediatrics 2005; 115: 1660-1665.
  • 2 Ammari A, Suri M, Milisavljevic V. et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr 2005; 147: 341-347.
  • 3 Avery ME, Tooley WH, Keller JB. et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 1987; 79: 26-30.
  • 4 Davis PG, Lemyre B, De Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2003; 2: CD000143.
  • 5 De Paoli AG, Davis PG, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in pre-term neonates. Cochrane Database Syst Rev 2008; 1: CD002977.
  • 6 Engle WA. and the Committee on Fetus and Newborn. Surfactant replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics 2008; 121: 419-432.
  • 7 Escobedo MB, Gunkel JH, Kennedy KA. et al. Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial. J Pediatr 2004; 144: 804-808.
  • 8 Finer NN, Carlo WA, Duara S. et al. Delivery room continuous positive airway pressure/positive endexpiratory pressure in extremely low birth weight infants: A feasibility trial. Pediatrics 2004; 114: 651-657.
  • 9 Fuchs H, Lindner W, Schmid S, Hummler H. Kriterien für die sekundäre Intubation und Surfactanttherapie bei Frühgeborenen <29 SSW mit Atemnotsyndrom. Zeitschrift für Geburtshilfe und Neonatologie 2008; 212 S1 PV11.
  • 10 Geary C, Caskey M, Fonseca R. et al. Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acis administration: A historical cohort study. Pediatrics 2008; 121: 89-96.
  • 11 Gortner L. Surfactanttherapie des neonatalen Atemnotsyndroms – RDS des Frühgeborenen.. AWMF-Leitlinien-Register 2005 Nr. 024/021.
  • 12 Gortner L, Wauer RR, Hammer H. et al. Early versus late surfactant treatment in preterm infants of 27 to 32 weeks’ gestational age: a multicenter controlled clinical trial. Pediatrics 1998; 102: 1153-1160.
  • 13 Kattwinkel J, Bloom BT, Delmore P. et al. Prophylactic administration of calf surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks’ gestation. Pediatrics 1993; 92: 90-98.
  • 14 Kugelman A, Feferkorn I, Riskin A. et al. Nasal inter-mittend mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: A randomized, controlled, prospective study. J Pediatrics 2007; 150: 521-526.
  • 15 Lindner W, Högel J, Pohlandt F. Sustained pressure-controlled inflation or intermittent mandatory ventilation in the delivery room? A randomised controlled trial on initial respiratory support via nasopharyngeal tube. Acta Pediatr 2005; 94: 303-309.
  • 16 Lindner W, Vossbeck S, Hummler H. et al. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?. Pediatrics 1999; 103: 961-967.
  • 17 Morley CJ, Davis PG, Doyle LW. et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358: 700-708.
  • 18 Poets CF, Sens B. Changes in intubation rates and outcome of very low birth weight infants: a population-based study. Pediatrics 1996; 98: 24-27.
  • 19 Soll RF, Morley C. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2001; 2: CD000510.
  • 20 Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Sys Rev 2007; 4: CD003063.
  • 21 Sweet D, Bevilaqua G, Carnielli V. et al. European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med 2007; 35: 175-186.
  • 22 Te Pas AB, Walther FJ. A randomized controlled trial of delivery room respiratory management in very preterm infants. Pediatrics 2007; 120: 322-329.