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Incidence and Outcome of CPAP Failure in Preterm Infants

Citation

Dargaville, PA and Gerber, A and Johansson, S and De Paoli, AG and Kamlin, COF and Orsini, F and Davis, PG, for the Australian and New Zealand Neonatal Network, Incidence and Outcome of CPAP Failure in Preterm Infants, Pediatrics (English Edition), 138, (1) Article e20153985. ISSN 0031-4005 (2016) [Refereed Article]

Copyright Statement

Copyright 2016 American Academy of Pediatrics

DOI: doi:10.1542/peds.2015-3985

Abstract

BACKGROUND AND OBJECTIVES: Data from clinical trials support the use of continuous positive airway pressure (CPAP) for initial respiratory management in preterm infants, but there is concern regarding the potential failure of CPAP support. We aimed to examine the incidence and explore the outcomes of CPAP failure in Australian and New Zealand Neonatal Network data from 2007 to 2013.

METHODS: Data from inborn preterm infants managed on CPAP from the outset were analyzed in 2 gestational age ranges (25-28 and 29-32 completed weeks). Outcomes after CPAP failure (need for intubation <72 hours) were compared with those succeeding on CPAP using adjusted odds ratios (AORs).

RESULTS: Within the cohort of 19 103 infants, 11 684 were initially managed on CPAP. Failure of CPAP occurred in 863 (43%) of 1989 infants commencing on CPAP at 25-28 weeks' gestation and 2061 (21%) of 9695 at 29-32 weeks. CPAP failure was associated with a substantially higher rate of pneumothorax, and a heightened risk of death, bronchopulmonary dysplasia (BPD) and other morbidities compared with those managed successfully on CPAP. The incidence of death or BPD was also increased: (25-28 weeks: 39% vs 20%, AOR 2.30, 99% confidence interval 1.71-3.10; 29-32 weeks: 12% vs 3.1%, AOR 3.62 [2.76-4.74]). The CPAP failure group had longer durations of respiratory support and hospitalization.

CONCLUSIONS: CPAP failure in preterm infants is associated with increased risk of mortality and major morbidities, including BPD. Strategies to promote successful CPAP application should be pursued vigorously.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Paediatrics
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Child Health
Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:110131
Year Published:2016
Web of Science® Times Cited:5
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-07-14
Last Modified:2017-11-06
Downloads:1 View Download Statistics

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