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Copyright © 2008 Massachussetts Medical Society. All rights reserved.

What’s the best type of ventilatory support for preterm infants?

NCPAP did not increase the rate of death or bronchopulmonary dysplasia and might provide some benefits for premature infants.

Preterm infants with bronchopulmonary dysplasia usually require ventilatory support. In a multisite clinical trial, researchers randomized 610 infants who were born at gestational ages of 25 through 28 weeks and who needed ventilatory support to receive nasal continuous positive airway pressure (NCPAP) or intubation plus ventilation at 5 minutes after birth. Infants who required immediate intubation were excluded, and infants randomized to NCPAP were intubated only if they had apnea, were acidotic (pH<7.25) and had partial pressure of arterial carbon dioxide >60 mm Hg, had metabolic acidosis unresponsive to treatment, or required treatment with more than 60% oxygen.

The primary outcome of death or bronchopulmonary dysplasia (defined as oxygen requirements at 36 weeks’ gestational age) did not differ significantly between the two groups (33.9% in the NCPAP group vs. 38.9% in the intubation group). However, at 28 days, infants who received NCPAP had a significantly lower rate of mortality or need for oxygen than those in the intubation group (54% vs. 65%). Infants in the NCPAP group also required fewer days of ventilation (21 vs. 26) and had less need for surfactant treatment (38% vs. 77%). Infants who received NCPAP had a …

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