Background

The use of continuous positive airway pressure (CPAP) applied early after birth improves several outcomes when compared with intubation and invasive mechanical ventilation. “Early CPAP” protocols vary in relation to the pressure level, type of interface used, and studied sample.

Objective

This study compared intubation rate, exogenous surfactant use, and hospitalization length (among other variables) prior to and after adopting an “early CPAP” protocol in preterm infants with gestational age between 28 and 32 weeks, using intermediate pressures and short binasal prongs.

Methods

This was a retrospective study conducted in a public university hospital in Brazil. All preterm infants with gestational age between 28 and 32 weeks were included in the study. The newborns born between January 2011 and December 2012, prior to the protocol being implemented, were considered the historical control group, and those born after implementation, between February 2013 and August 2014 were considered the intervention group.

Results

The participants in both groups had similar baseline characteristics (p > 0.05). There were significant reductions in intubation rate (89% versus 73%, p = 0.02), exogenous surfactant use (86% versus 67%, p = 0.02), and median (Q1 - Q3) days of invasive mechanical ventilation [4 (2 - 14) versus 1 (0.15–9), p = 0.01] and length of hospital stay in days [56 (42–77) versus 42 (35–71), p = 0.02].

Conclusions

The findings demonstrate positive outcomes of the early CPAP protocol. This protocol used simple and affordable equipment available in the hospital which could easily be reproduced in other centers, generating better outcomes for preterm infants and reducing hospital expenses.

中文翻译：

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胎龄在 28 至 32 周之间的早产儿的早期 CPAP 协议：公立医院的经验

背景

与插管和有创机械通气相比，出生后早期应用持续气道正压通气 (CPAP) 可改善多种结局。“早期 CPAP”协议因压力水平、使用的接口类型和研究样本而异。

客观的

本研究比较了胎龄在 28 至 32 周之间的早产儿在采用“早期 CPAP”方案之前和之后的插管率、外源性表面活性剂的使用和住院时间（以及其他变量），使用中等压力和短双鼻叉。

方法

这是一项在巴西公立大学医院进行的回顾性研究。研究中包括所有胎龄在 28 至 32 周之间的早产儿。2011 年 1 月至 2012 年 12 月之间出生的新生儿，即方案实施之前，被视为历史对照组，实施后，2013 年 2 月至 2014 年 8 月之间出生的新生儿被视为干预组。

结果

两组参与者具有相似的基线特征（p > 0.05）。插管率（89%对73%，p = 0.02）、外源性表面活性剂的使用（86%对67%，p = 0.02）和有创机械通气的中位 (Q1 - Q3) 天数显着降低 [4 (2) - 14)对比1 (0.15-9)，p = 0.01] 和住院天数 [56 (42-77)对比42 (35-71)，p = 0.02]。

结论

研究结果证明了早期 CPAP 协议的积极成果。该协议使用医院提供的简单且负担得起的设备，这些设备可以很容易地在其他中心复制，为早产儿带来更好的结果并减少住院费用。