CPAP can be used as initial ventilatory support in extremely preterm infants

Little is known about the optimal ventilatory strategy in extremely preterm infants. NICHD Neonatal Research Network now publishes a trial including 1316 preterm infants born before 28 weeks, randomly assigned to intubation and surfactant treatment (within 1 hour after birth) or to CPAP treatment initiated in the delivery room, with subsequent use of a protocol-driven limited ventilation strategy.

The rate of the primary outcome death or bronchopulmonary dysplasia did not differ significantly between the CPAP group and the surfactant group. Compared to the group of infants randomized to mechanical ventilation, the infants in the CPAP group less frequently required intubation or postnatal corticosteroids for bronchopulmonary dysplasia, required fewer days of mechanical ventilation, and were more likely to be alive and free from the need for mechanical ventilation by day 7.

The authors conclude that CPAP could be considered as initial ventilatory support among extremely preterm infants, as an alternative to intubation and surfactant.

Published online at www.nejm.org May 16, 2010 (10.1056/NEJMoa0911783)