Perinatal factors related to the failure of early continuous nasal positive pressure in very low birth weight and premature newborn.
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Abstract
Introduction: The use of continuous positive airway pressure (CPAP) is associated with reduction in invasive mechanical ventilation and related morbidities in neonates. Understanding the reasons why some newborns failure in this ventilation modality is important. Objective: To evaluate perinatal factors that interfere with the failure of early CPAP in very low birth weight infants (VLBW). Methods: Prospective and observational study in which VLBW infants who received CPAP as the first ventilation modality were divided into those who failed and those who did not fail to adapt to CPAP and compared to maternal and neonatal characteristics. The means of the continuous variables were compared by the t-test, the frequencies by the chi-square test and the logistic regression was used to quantify the correlation between the significant variables and the failure
in early CPAP. Statistical package SPSS 16.0 was used and
significance was considered <0.05. Results: 167 VLBW infants were evaluated. Being SGA decreased CPAP failure by 80%; requiring resuscitation at birth, presenting SNAPPE score >12 and being male increased the chance of CPAP failure by 2.5, 2.3 and 2.2 times respectively (p<0.05). Birth weight, gestational age and other perinatal variables did not independently interfere with CPAP failure. Conclusions: VLBW infants who failed to use nasal CPAP were sicker at birth and were mostly male. Being born SGA decreased CPAP failure.
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References
1. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, te Pas A; et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019; 115:432-50.
2. Afjeh SA, Sabzehei MK, Khoshnood Shariati M, Shamshiri AR, Esmaili F. Evaluation of Initial Respiratory Support Strategies in VLBW Neonates with RDS. Arch Iran Med. 2017; 20(3):158-64.
3. Suguihara C, Lessa AC. Como minimizar a lesão pulmonar no prematuro extremo: propostas. J Pediatr (Rio J). 2005; 81(1 Supl):69-78.
4. Boo NY, Zuraidah AL, Lim NL, Zulfiqar MA. Predictors of failure of nasal continuous positive airway pressure in treatment of preterm infants with respiratory distress syndrome. J Trop Pediatr. 2000; 46:172-5.
5. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010; 362:1970-9.
6. Ammari A, Suri M, Milisavljevic V, Sahni R, Bateman D, Sanocka U; et al. Variables associated with the early fai lure of nasal CPAP in very low birth weight infants. J Pediatr. 2005; 147:341-7.
7. De Jaegere AP, Van der Lee JH, Canté C, Van Kaam AH. Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation. Acta Paediatrica. 2012;101:374-9.
8. Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age. Arch Dis Child Fetal Neonatal. 2011; 96:343-7.
9. Dargaville PA, Aiyappan A, De Paoli AG, Dalton RG, Kuschel CA, Kamlin CO, et al. Continuous Positive Airway Pressure Failure in Preterm Infants: Incidence, Predictors and Consequences. Neonatology. 2013; 104:8-14.
10. World Health Organization (WHO). Provision of effective antenatal care: Integrated management of pregnancy and childbirth (IMPAC). Standards for Maternal and Neonatal Care. Geneva: World Health Organisation; 2006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293995/ (acessado em 26 jun. 2017).
11. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas. Gestação de alto risco: manual técnico. 5 ed. Brasília: Ministério da Saúde; 2012. (Série A. Normas e Manuais Técnicos).
12. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991; 119:417-23.
13. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996; 87:163-8.
14. International Neonatal Network (INN). The CRIB (Clinical Risk Index for Babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The Lancet. 1993; 342:193-8.
15. Richardson DK, Phibbs CS, Gray JE, McCormick MC, Workman-Daniels K, Goldmann DA. Birth weight and illness severity: independent predictors of neonatal mortality. Pediatrics. 1993; 915:969-75.
16. Almeida MFB, Guinsburg R. Reanimação neonatal em sala de parto: Documento Científico do Programa de Reanimação Neonatal da Sociedade Brasileira de Pediatria. Disponível em: http://www.sbp.com.br/content/userfiles/image/../prn-sbp-reanimacaoneonatal-atualizacao-1abr2013.pdf. Acesso em: 29 dez.2013.
17. Sandri F, Ancora G, Lanzoni A, Tagliabue P, Colnaghi M, Ventura ML; et al. Prophylactic nasal continuous positive airways pressure in newborns of 28-31 weeks gestation: multicentre randomised controlled clinical trial. Arch Dis Child Fetal Neonatal. 2004; 89:394-8.
18. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Atenção à saúde do recém-nascido: guia para os profissionais de saúde. 2 ed. Brasília: Ministério da Saúde; 2012.
19. Yagui ACZ, Vale LAPA, Haddad LB, Prado C, Rossi FS, Deutsch ADA, et al. CPAP em selo d'água versus CPAP com fluxo variável em recém-nascidos com desconforto respiratório: um ensaio controlado randomizado. J Pediatr (Rio J). 2011; 87(6):499-504.
20. Mazela J, Bonet M, Piedvache A, Pryds O, Truffert P, Jarreau PH, et al. CPAP Failure In Very Preterm Infants In European Regions With Different Respiratory Management Strategies: Results From The Epice Cohort. Archives of Disease in Childhood. 2014; 99(Suppl 2):500.
21. Pillai MS, Sankar MJ, Mani K, Agarwal R, Paul VK, Deorari AK. Clinical Prediction Score for Nasal CPAP Failure in Preterm VLBW Neonates with Early Onset Respiratory Distress. J Trop Pediatr.2011; 57:274-9.
22. Gonçalves-Ferri WA, Martinez FE, Caldas JP, Marba ST, Fekete S, Rugolo L, et al. Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial. Braz J Med Biol Res. 2014; 47:259-64.
23. Malhotra A, Sasi A, Miller SL, Jenkin G, Polglase GR. The Efficacy of Surfactant Replacement Therapy in the Growth-Restricted Preterm Infant: What is the Evidence? Front Pediatr. 2014; 2:1-5.
24. Tyson JE, Kennedy K, Broyles S, Rosenfeld CR. The small for gestational age infant: accelerated or delayed pulmonary maturation? Increased or decreased survival? Pediatrics. 1995; 95(4):534-8.
25. Drummond S, Souza TS, Lima FG, Vieira, AA. Correlação entre o uso de corticoterapia antenatal, a reanimação e a mortalidade de recém-nascidos prematuros de muito baixo peso. Rev. Bras. Ginecol. Obstet. 2014; 36:211-5.
26. Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S, et al. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics. 2010; 125:1402-9.
27. Crowther CA, McKinlay CJD, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database of Systematic Reviews. 2015; 7.
28. Dargaville PA, Gerber A, Johansson S, De Paoli AG, Kamlin COF, Orsini F, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics. 2016; 138.
29. Rocha G, Flôr-de-Lima F, Proença E, Carvalho C, Quintas C, Martins T, et al. Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation. J Perinatol. 2013; 33:297-301.
30. Gulczyńska E, Szczapa T, Hożejowski R, Borszewska-Kornacka M K, Rutkowska M. Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study. Neonatology. 2019; 21:1-8.