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CPAP Found Feasible for Extremely Preterm Infants

Last Updated: May 17, 2010.

In extremely preterm infants, early treatment with continuous positive airway pressure may be a viable alternative to early treatment with intubation and surfactant, according to a study published online May 16 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 14 to 19 in New Orleans. The study also found that a lower target range of oxygen saturation does not reduce a composite of severe retinopathy or death and may be associated with increased mortality.

MONDAY, May 17 (HealthDay News) -- In extremely preterm infants, early treatment with continuous positive airway pressure (CPAP) may be a viable alternative to early treatment with intubation and surfactant, according to a study published online May 16 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 14 to 19 in New Orleans. The study also found that a lower target range of oxygen saturation does not reduce a composite of severe retinopathy or death and may be associated with increased mortality.

In one part of the study, Neil N. Finer, M.D., of the University of California at San Diego, and colleagues randomly assigned 1,316 infants to receive either intubation and surfactant treatment or CPAP treatment. They found that the rate of the primary outcome -- death or bronchopulmonary dysplasia -- was not significantly different in the CPAP group and surfactant group (47.8 and 51 percent, respectively).

In a second part of the study, Waldemar A. Carlo, M.D., of the University of Alabama at Birmingham, and colleagues randomly assigned the same group of infants to receive oxygen saturation of either 85 to 89 percent or 91 to 95 percent. Compared to the higher range of oxygen saturation, they found that the lower range did not significantly decrease the primary composite outcome: severe retinopathy or death. However, they also found that a lower range was associated with increased mortality and decreased severe retinopathy among survivors.

"How do the results of this trial help neonatologists? They show that starting CPAP at birth in very preterm babies, even if it fails in some, has important benefits and no serious side effects," writes the author of an accompanying editorial. "Predicting which babies will not have an adequate response to treatment with CPAP and should therefore receive early ventilation and surfactant should be a future goal. Targeting oxygen saturation levels is difficult, and a recommended oxygen saturation range that is effective yet safe remains elusive."

One author disclosed financial ties to Ikaria Holdings.

Abstract - Finer
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Abstract - Carlo
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