Noninvasive Respiratory Support Reduces Bronchopulmonary Dysplasia in Preterm Infants

Robin Steinhorn, MD

A meta-analysis of four trials indicates that early nasal CPAP is superior to intubation as primary respiratory support.

Noninvasive respiratory support modalities such as nasal continuous positive airway pressure (CPAP) have been widely adopted in the management of preterm infants to reduce lung injury and improve outcomes. However, even large randomized studies have generally not shown clear-cut reductions in death or bronchopulmonary dysplasia. These authors conducted a meta-analysis of data from four randomized controlled trials (2782 infants) that compared nasal CPAP and endotracheal intubation as the primary mode of respiratory support after birth in preterm infants (<32 weeks' gestation). All four trials reported outcomes of death or bronchopulmonary dysplasia (defined as the need for oxygen support or mechanical ventilation at 36 weeks' corrected gestation). In one trial, endotracheal intubation was only used for a brief (<1 hour) interval for administration of prophylactic surfactant.

Overall, 40% of 1296 infants in the nasal CPAP group required intubation within the first week after birth. CPAP was associated with a reduction in bronchopulmonary dysplasia of borderline significance (relative risk, 0.91) and a significant reduction in the combined outcome of death or bronchopulmonary dysplasia or both at 36 weeks' gestation (RR, 0.91; number needed to treat, 25). Secondary outcomes (including postnatal corticosteroid treatment, retinopathy of prematurity, patient ductus arteriosus) did not differ significantly between the two groups.

Citation(s):

Schmölzer GM et al. Non-invasive versus invasive respiratory support in preterm infants at birth: Systematic review and meta-analysis. BMJ 2013 Oct 17; 347:f5980.