Continuous distending pressure for respiratory distress in preterm infants

Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG

Published Online:

October 8, 2008

Some benefits found in using continuous distending pressure (CDP) for respiratory distress syndrome in preterm babies.

Respiratory distress syndrome (RDS) is the most common cause of disease and death in babies born before 34 weeks gestation. Intermittent positive pressure ventilation (IPPV) is the standard way of helping these babies breathe. A simpler method of assisting breathing is to provide a continuous lung distending pressure - either no continuous positive pressure to the airway or continuous negative pressure (partial vacuum). The review of trials found that continuous distending pressure (CDP) reduces the rate of death or the need for assisted ventilation and reduced the need for IPPV. The small and mostly dated trials also found that CDP can increase the rate of pneumothorax (air outside the lung in the chest cavity).

Abstract (click to read)

Background:

Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants (Greenough 1998, Bancalari 1992). Intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition. The major difficulty with IPPV is that it is invasive, resulting in airway and lung injury and contributing to the development of chronic lung disease.

Objectives:

To determine the effect of continuous distending pressure (CDP) on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.

Search strategy:

The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2008), MEDLINE (1966 - February, 2008), and EMBASE (1980 - February 2008), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.

Selection criteria:

All trials using random or quasi-random allocation of preterm infants with respiratory distress were eligible. Interventions were continuous distending pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharyngeal tube, or endotracheal tube, or continuous negative pressure (CNP) via a chamber enclosing the thorax and lower body, compared with standard care.

Data collection and analysis:

Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by each author.

Main results:

CDP is associated with a lower rate of failed treatment (death or use of assisted ventilation) [summary RR 0.65 (95% CI 0.52, 0.81), RD -0.20 (95% CI -0.29, -0.10), NNT 5 (95% CI 4, 10)], overall mortality [summary RR 0.52 (95% CI 0.32, 0.87), RD -0.15 (95% CI -0.26, -0.04), NNT 7 (95% CI 4, 25)], and mortality in infants with birth weights above 1500 g [summary RR 0.24 (95% CI 0.07, 0.84), RD -0.28 (95% CI -0.48, -0.08), NNT 4 (95% CI 2, 13)]. The use of CDP is associated with an increased rate of pneumothorax [summary RR 2.64 (95% CI 1.39, 5.04), RD 0.10 (95% CI 0.04, 0.17), NNH 17 (95% CI 17, 25)].

Authors' conclusions:

In preterm infants with respiratory distress the application of CDP either as CPAP or CNP is associated with reduced respiratory failure and reduced mortality. CDP is associated with an increased rate of pneumothorax. Four out of six of these trials were done in the 1970's. Therefore, the applicability of these results to current practice is difficult to assess. Where resources are limited, such as in developing countries, CPAP for RDS may have a clinical role. Further research is required to determine the best mode of administration and the role of CDP in modern intensive care settings

This record should be cited as:

Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG. Continuous distending pressure for respiratory distress in preterm infants. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002271. DOI: 10.1002/14651858.CD002271

Assessed as up to date:

May 24, 2008

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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

Continuous distending pressure for respiratory distress in preterm infants

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