Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants
Background Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the u...
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| description | Background
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Search methods
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All randomised or quasi‐randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
Data collection and analysis
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non‐tertiary hospitals; high income compared with low income)
Main results
We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial.
CPAP was associated with lower risk of treatment failure (dea |
| doi_str_mv | 10.1002/14651858.CD002271.pub3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8094155</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2451853855</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4733-644c548b1a46f7acd53816ec38f031e4c013807cce933b1b1dd828017750e5433</originalsourceid><addsrcrecordid>eNqFUctOwzAQtBCIlsIvVDmWQ4od24l7QSrhKSHRA3C1HMehRkkc7KRV_p6EPlS4cPJ6Zzyz3gFgjOAUQRhcIRJSxCibxrfdNYjQtGoSfASGPeD3yPFBPQBnzn1CiMNZEJ2CAcaQsgCyIXiPTVnrsjGN8yrjdK1XyhParkXrVVY511jlTeLFfHHpZcZ6XavSVtTGtl6qXd1TPF323FrZoiszUdbuHJxkInfqYnuOwNv93Wv86D-_PDzF82dfkghjPyREUsISJEiYRUKmFDMUKolZBjFSREKEGYykVDOME5SgNGUBgyiKKFSUYDwC1xvd7veFSqUqaytyXlldCNtyIzT_jZR6yT_MijM4I4jSTmCyFbDmq1Gu5oV2UuW5KFW3Ex6Qfs2Y_VDDDVVa45xV2d4GQd6Hwneh8F0ovXk_5PhwyP2zXQod4WZDWOtctVwaubSd_z-6f1y-Ae9vndk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2451853855</pqid></control><display><type>article</type><title>Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Cochrane Library</source><source>Alma/SFX Local Collection</source><creator>Ho, Jacqueline J ; Ho, Jacqueline J ; Subramaniam, Prema ; Davis, Peter G</creator><creatorcontrib>Ho, Jacqueline J ; Ho, Jacqueline J ; Subramaniam, Prema ; Davis, Peter G</creatorcontrib><description>Background
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Search methods
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All randomised or quasi‐randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
Data collection and analysis
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non‐tertiary hospitals; high income compared with low income)
Main results
We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial.
CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) –0.19, 95% CI –0.28 to –0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low‐certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD –0.13, 95% CI –0.25 to –0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low‐certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD –0.11, 95% CI –0.18 to –0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate‐certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low‐certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low‐certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood.
Authors' conclusions
In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource‐poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD002271.pub3</identifier><identifier>PMID: 33058208</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Bronchopulmonary Dysplasia ; Bronchopulmonary Dysplasia - etiology ; Child health ; Continuous Positive Airway Pressure ; Continuous Positive Airway Pressure - adverse effects ; Continuous Positive Airway Pressure - methods ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Intermittent Positive-Pressure Ventilation - adverse effects ; Lungs & airways ; Mechanical ventilation ; Medicine General & Introductory Medical Sciences ; Neonatal care ; Neonatal respiratory distress syndrome ; Other Interventions ; Outcome Assessment, Health Care ; Pneumothorax ; Pneumothorax - etiology ; Pulmonary Surfactants ; Pulmonary Surfactants - therapeutic use ; Randomized Controlled Trials as Topic ; Respiratory Disorders ; Respiratory Distress Syndrome ; Respiratory Distress Syndrome, Newborn ; Respiratory Distress Syndrome, Newborn - mortality ; Respiratory Distress Syndrome, Newborn - therapy ; Respiratory Insufficiency ; Respiratory Insufficiency - prevention & control ; Selection Bias ; Treatment Failure</subject><ispartof>Cochrane database of systematic reviews, 2020-10, Vol.2020 (10), p.CD002271</ispartof><rights>Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4733-644c548b1a46f7acd53816ec38f031e4c013807cce933b1b1dd828017750e5433</citedby><cites>FETCH-LOGICAL-c4733-644c548b1a46f7acd53816ec38f031e4c013807cce933b1b1dd828017750e5433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33058208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ho, Jacqueline J</creatorcontrib><creatorcontrib>Ho, Jacqueline J</creatorcontrib><creatorcontrib>Subramaniam, Prema</creatorcontrib><creatorcontrib>Davis, Peter G</creatorcontrib><title>Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Search methods
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All randomised or quasi‐randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
Data collection and analysis
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non‐tertiary hospitals; high income compared with low income)
Main results
We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial.
CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) –0.19, 95% CI –0.28 to –0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low‐certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD –0.13, 95% CI –0.25 to –0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low‐certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD –0.11, 95% CI –0.18 to –0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate‐certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low‐certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low‐certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood.
Authors' conclusions
In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource‐poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.</description><subject>Bronchopulmonary Dysplasia</subject><subject>Bronchopulmonary Dysplasia - etiology</subject><subject>Child health</subject><subject>Continuous Positive Airway Pressure</subject><subject>Continuous Positive Airway Pressure - adverse effects</subject><subject>Continuous Positive Airway Pressure - methods</subject><subject>Humans</subject><subject>Infant, Low Birth Weight</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Intermittent Positive-Pressure Ventilation</subject><subject>Intermittent Positive-Pressure Ventilation - adverse effects</subject><subject>Lungs & airways</subject><subject>Mechanical ventilation</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Neonatal care</subject><subject>Neonatal respiratory distress syndrome</subject><subject>Other Interventions</subject><subject>Outcome Assessment, Health Care</subject><subject>Pneumothorax</subject><subject>Pneumothorax - etiology</subject><subject>Pulmonary Surfactants</subject><subject>Pulmonary Surfactants - therapeutic use</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Respiratory Disorders</subject><subject>Respiratory Distress Syndrome</subject><subject>Respiratory Distress Syndrome, Newborn</subject><subject>Respiratory Distress Syndrome, Newborn - mortality</subject><subject>Respiratory Distress Syndrome, Newborn - therapy</subject><subject>Respiratory Insufficiency</subject><subject>Respiratory Insufficiency - prevention & control</subject><subject>Selection Bias</subject><subject>Treatment Failure</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUctOwzAQtBCIlsIvVDmWQ4od24l7QSrhKSHRA3C1HMehRkkc7KRV_p6EPlS4cPJ6Zzyz3gFgjOAUQRhcIRJSxCibxrfdNYjQtGoSfASGPeD3yPFBPQBnzn1CiMNZEJ2CAcaQsgCyIXiPTVnrsjGN8yrjdK1XyhParkXrVVY511jlTeLFfHHpZcZ6XavSVtTGtl6qXd1TPF323FrZoiszUdbuHJxkInfqYnuOwNv93Wv86D-_PDzF82dfkghjPyREUsISJEiYRUKmFDMUKolZBjFSREKEGYykVDOME5SgNGUBgyiKKFSUYDwC1xvd7veFSqUqaytyXlldCNtyIzT_jZR6yT_MijM4I4jSTmCyFbDmq1Gu5oV2UuW5KFW3Ex6Qfs2Y_VDDDVVa45xV2d4GQd6Hwneh8F0ovXk_5PhwyP2zXQod4WZDWOtctVwaubSd_z-6f1y-Ae9vndk</recordid><startdate>20201015</startdate><enddate>20201015</enddate><creator>Ho, Jacqueline J</creator><creator>Ho, Jacqueline J</creator><creator>Subramaniam, Prema</creator><creator>Davis, Peter G</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20201015</creationdate><title>Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants</title><author>Ho, Jacqueline J ; Ho, Jacqueline J ; Subramaniam, Prema ; Davis, Peter G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4733-644c548b1a46f7acd53816ec38f031e4c013807cce933b1b1dd828017750e5433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bronchopulmonary Dysplasia</topic><topic>Bronchopulmonary Dysplasia - etiology</topic><topic>Child health</topic><topic>Continuous Positive Airway Pressure</topic><topic>Continuous Positive Airway Pressure - adverse effects</topic><topic>Continuous Positive Airway Pressure - methods</topic><topic>Humans</topic><topic>Infant, Low Birth Weight</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Intermittent Positive-Pressure Ventilation</topic><topic>Intermittent Positive-Pressure Ventilation - adverse effects</topic><topic>Lungs & airways</topic><topic>Mechanical ventilation</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Neonatal care</topic><topic>Neonatal respiratory distress syndrome</topic><topic>Other Interventions</topic><topic>Outcome Assessment, Health Care</topic><topic>Pneumothorax</topic><topic>Pneumothorax - etiology</topic><topic>Pulmonary Surfactants</topic><topic>Pulmonary Surfactants - therapeutic use</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Respiratory Disorders</topic><topic>Respiratory Distress Syndrome</topic><topic>Respiratory Distress Syndrome, Newborn</topic><topic>Respiratory Distress Syndrome, Newborn - mortality</topic><topic>Respiratory Distress Syndrome, Newborn - therapy</topic><topic>Respiratory Insufficiency</topic><topic>Respiratory Insufficiency - prevention & control</topic><topic>Selection Bias</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ho, Jacqueline J</creatorcontrib><creatorcontrib>Ho, Jacqueline J</creatorcontrib><creatorcontrib>Subramaniam, Prema</creatorcontrib><creatorcontrib>Davis, Peter G</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ho, Jacqueline J</au><au>Ho, Jacqueline J</au><au>Subramaniam, Prema</au><au>Davis, Peter G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2020-10-15</date><risdate>2020</risdate><volume>2020</volume><issue>10</issue><spage>CD002271</spage><pages>CD002271-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Search methods
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All randomised or quasi‐randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
Data collection and analysis
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non‐tertiary hospitals; high income compared with low income)
Main results
We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial.
CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) –0.19, 95% CI –0.28 to –0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low‐certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD –0.13, 95% CI –0.25 to –0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low‐certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD –0.11, 95% CI –0.18 to –0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate‐certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low‐certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low‐certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood.
Authors' conclusions
In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource‐poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>33058208</pmid><doi>10.1002/14651858.CD002271.pub3</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2020-10, Vol.2020 (10), p.CD002271 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8094155 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Cochrane Library; Alma/SFX Local Collection |
| subjects | Bronchopulmonary Dysplasia Bronchopulmonary Dysplasia - etiology Child health Continuous Positive Airway Pressure Continuous Positive Airway Pressure - adverse effects Continuous Positive Airway Pressure - methods Humans Infant, Low Birth Weight Infant, Newborn Infant, Premature Intermittent Positive-Pressure Ventilation Intermittent Positive-Pressure Ventilation - adverse effects Lungs & airways Mechanical ventilation Medicine General & Introductory Medical Sciences Neonatal care Neonatal respiratory distress syndrome Other Interventions Outcome Assessment, Health Care Pneumothorax Pneumothorax - etiology Pulmonary Surfactants Pulmonary Surfactants - therapeutic use Randomized Controlled Trials as Topic Respiratory Disorders Respiratory Distress Syndrome Respiratory Distress Syndrome, Newborn Respiratory Distress Syndrome, Newborn - mortality Respiratory Distress Syndrome, Newborn - therapy Respiratory Insufficiency Respiratory Insufficiency - prevention & control Selection Bias Treatment Failure |
| title | Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants |
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