Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant
Article first published online: 29 OCT 2010
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Pædiatrica
Volume 99, Issue 12, pages 1807–1811, December 2010
How to Cite
Ancora, G., Maranella, E., Grandi, S., Pierantoni, L., Guglielmi, M. and Faldella, G. (2010), Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant. Acta Paediatrica, 99: 1807–1811. doi: 10.1111/j.1651-2227.2010.01910.x
- Issue published online: 29 OCT 2010
- Article first published online: 29 OCT 2010
- Received 25 January 2010; Revised 2 April 2010; accepted 31 May 2010.
- Continuous positive airway pressure;
- Premature infant;
- Pulmonary surfactants;
- Respiratory distress syndrome
Aim: Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV).
Methods: Chart data of infants with a birth weight <1500 gr or GA <32 weeks undergoing InSurE in the period 2002–2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO2 >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure.
Results: Six of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001).
Conclusions: BiPAP reduced the need for MV after InSurE failure.