Hello everybody,

I am wondering if you treat term or near term infants with CPAP (if they need breathing support) in the delivery room.

The background of my question is an ongoing discussion whether term/near term infants (GA >=35+0) should receive postnatal delivery room CPAP.

As far as I know are there three studies of two centre published describing an increase in PTX occurrence after implementing CPAP in the delivery room:

https://pubmed.ncbi.nlm.nih.gov/25854822/ (Pulmonary air leak associated with CPAP at term birth resuscitation)

https://pubmed.ncbi.nlm.nih.gov/31399490/ (Delivery Room Continuous Positive Airway Pressure and Pneumothorax)

https://pubmed.ncbi.nlm.nih.gov/35173286/ (Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age)

This leads me to two question:

1) Do you treat term and near term infants (GA>=35+0) needing pulmonary transition help with nCPAP in the delivery room?

2) What are the criteria to start nCPAP?

Thanks for all your answers in advance

With kind regards

Dirk

This is the guidelines I developed for the situation you are describing. It will be our standard approach at my institution

Hi Dirk, 

 

• I think all these studies state association rather than causation, as PTX is common in term infants even in those who do not have RDS or need resuscitation  
• If the baby has significant work of breathing then CPAP is required to keep the lung open, giving oxygen won't cut it and intubation is worst than CPAP
• If the baby does not have work of breathing but is hypoxic, LFNC should be enough 

I hope this is helpful

 

 

 

Thanks to Nathan for sharing this nice summary of the findings and the clinical guideline.

And I fully agree to Mo7 that PTX and CPAP is rather an association than a causation.

With kind regards

Dirk

We do this regularly at Sachs Children’s - works well and (IMO) reduces NICU admissions