Continuous distending pressure for respiratory distress in preterm infants

Cochrane Review by Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG

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.

ABSTRACT

Title

Continuous distending pressure for respiratory distress in preterm infants

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.

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