Hello,

I wonder if do you use CPAP at birth in apparently healthy (with good inspiratory efforts) preterm newborns (32-36 weeks G.E.,) to improve lung recruitment or "to prevent" RDS and how (for e.g. do you use sustained inflation?).

 

Thanks for your answers

 

Marcello De Filippo

Neonatologist

II level NICU - Grosseto - Italy

Only if the baby has grunting or increased respiratory efforts. On the other hand, we apply CPAP (through NeoPuff) liberally , i.e. even if the baby has minor grunting etc.

But we do not use sustained inflation.

 

BTW, we published a review on EBNEO.org recently about sustained lung inflation.

https://ebneo.org/2015/04/prophylactic-sustained-lung-inflation-followed-by-early-cpap-versus-early-cpap-at-birth-in-extreme-preterm-neonates/

We also have liberal use of CPAP after birth, so if in doubt about respiratory effort of baby we support (with Perivent). No sustained inflations either in this age group.

We use a T-piece resuscitator (NeoPuff, Fischer and Paykel) for all preemies, not only those in the group in question (32-36 weeks GA). 

 

We did try SLI a few times, but many in my team were not happy with it, and in all probability we were not doing it right either! We also don't regularly use nasal CPAP in the delivery room, but hook them on to the NeoPuff, which we use in short bursts, especially during transfer to the NICU, where the babies can be put on nCPAP or heated and humidified high flow oxygen via nasal canulae, as the case might be.

 

So, in effect, all preemies get the T-piece transfer to our NICU, where the ones with grunting and retractions get nCPAP, and the others get HHHFNC oxygen. Both are weaned or upgraded to mechanical ventilation according to their response, following the standard protocols.

Only if there are signs of respiratory distress.

Using the Neo-Tee^® to deliver CPAP and/or PPV in the delivery room

 

We have found the Neo-Tee^® to be the very best device to safely deliver CPAP and/or PPV in the delivery room setting, period.  

 

We routinely give CPAP using the Neo-Tee^® for all cesarean section births to promote alveolar stability and enhance alveolar recruitment (volume). As a matter of fact, we have the Neo-Tee^® available for all births for immediate implementation whenever CPAP is needed.

 

The application of the Neo-Tee^® mask CPAP usually lasts for only a few breaths, but it makes all the difference in the world and allows for the baby to be transferred to the LDRP rather than the NICU.

 

The successful transition from fetal circulation to pulmonary circulation depends in large part, on the neonate’s ability to achieve a stable functional residual capacity (FRC) immediately following birth. This challenge is made more difficult following a cesarean section birth where the neonate does not have the benefit of the normal birth mechanics and the resulting reduced work of breathing during the important first few breaths. That is when the neonate attempts to establish their FRC.

 

The challenge in these neonates is to achieve and maintain an adequate FRC, thus allowing alveolar stability and optimizing alveolar volume or recruitment.

 

Achieving alveolar stability means that the neonates first few spontaneous breaths must be efficient enough to achieve and maintain an adequate alveolar volume. Otherwise, transition to a normal pulmonary circulation will never be accomplished.

 

Maintaining alveolar stability also means that there is adequate end expiratory alveolar volume to prevent alveolar collapse and loss of alveolar recruitment or volume. The only strategy that has proven to promote alveolar stability and enhance alveolar recruitment (volume) in the delivery room and the NICU is CPAP in one form or another.

Chandler