Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants

Premature babies often lack the substance, surfactant, a detergent like substance produced by the lung. This causes their lungs to fail to expand properly at birth, and breathing in requires a big effort. If left untreated, breathing difficulty progressively worsens and it may cause damage to the lung. Continuous distending pressure (CDP) improves the expansion of the lung making it easier for the premature baby to breath. It is applied through a face mask, or into the nostrils or by a partial vacuum outside the chest. When applied early, it may also reduce the lung damage that causes chronic lung disease. Different ways of using CDP were assessed in six controlled trials (four randomized), and it was found that fewer infants who received early CDP had to go on to be treated with intermittent positive pressure ventilation. No adverse effect of early use of CDP was found in these trials. However, there were several limitations to information from the studies, as the number of infants was small and the mean age ranged from seven to eighteen hours old when CDP was applied. Practice has changed from when these studies were done. CDP interventions are applied earlier, and surfactants are commonly given as well. Corticosteroids are given to the fetus before birth (antenatally) to prepare their lungs for birth.