Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants

Subramaniam P, Henderson-Smart DJ, Davis PG

Published Online:

January 21, 2009

There is not enough evidence to show the effect of continuous positive airways pressure (CPAP) applied through the nose to prevent respiratory problems in preterm babies. Preterm babies (born before 37 weeks) may need help to breathe properly. These babies can be helped to breathe mechanically by intermittent airflow via a tube placed in their windpipe (Intermittent Positive Pressure Ventilation, IPPV) but this is invasive and may be associated with complications. They can also be given continuous pressure in their airways by controlling the pressure of the gas entering the nose. The review did not find enough evidence from trials to show the effect of using prophylactic nasal CPAP to prevent respiratory problems requiring IPPV. More research is needed.

Abstract (click to read)

Background:

Cohort studies (Avery 1987; Jonsson 1997) have suggested that early post-natal nasal continuous positive airways pressure (CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation, and in preventing chronic lung disease in preterm or low birth weight infants.

Objectives:

To determine if prophylactic nasal CPAP commenced soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of chronic lung disease (CLD) without adverse effects.

Search strategy:

The search was updated in April 2005. The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Library Issue 1 2005, MEDLINE 1966-April 2005, previous reviews including cross references, abstracts, conferences, symposia, proceedings, expert informants, journal hand searching mainly in the English language.

Selection criteria:

All trials using random or quasi-random patient allocation of very preterm infants < 32 weeks gestation and / or < 1500 gms at birth were eligible. Comparison had to be between prophylactic nasal CPAP commencing soon after birth regardless of the respiratory status of the infant compared with "standard" methods of treatment where CPAP or IPPV is used for a defined respiratory condition.

Data collection and analysis:

Standard methods of the Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each author, were used. Data were analysed using relative risk (RR). Meta-analysis was performed using a fixed effects model.

Main results:

There are no statistically significant differences in any of the outcomes studied in either of the eligible trials (Han 1987; Sandri 2004) reporting on 82 and 230 infants respectively. In Han 1987 there are trends towards increases in the incidence of BPD at 28 days [RR 2.27 (0.77, 6.65)], death [RR 3.63 (0.42, 31.08)] and any IVH [RR 2.18 (0.84, 5.62)] in the CPAP group. In Sandri 2004 there is a trend towards an increase in IVH grade 3 or 4 [RR 3.0 (0.96, 28.42)] in the CPAP group. No outcome was significantly different in any of the meta-analyses.

Authors' conclusions:

There is currently insufficient information to evaluate the effectiveness of prophylactic nasal CPAP in very preterm infants. Neither of the included studies reviewed showed evidence of benefit in reducing the use of IPPV. The tendency for some adverse outcomes to be increased is of concern and further multicentre randomized controlled trials are needed to clarify this.

This record should be cited as:

Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD001243. DOI: 10.1002/14651858.CD001243.pub2

Assessed as up to date:

April 20, 2005

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Mechanical ventilation

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants

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