How to deliver CPAP

Two almost simultaneous articles, one from the Melbourne group. One from Colm O’Donnell in Dublin who has worked with the Melbourne group in the past

Kamlin COF, Schilleman K, Dawson JA, Lopriore E, Donath SM, Schmölzer GM, Walther FJ, Davis PG, te Pas AB: Mask Versus Nasal Tube for Stabilization of Preterm Infants at Birth: A Randomized Controlled Trial. Pediatrics 2013, 132(2):e381-e388. If you are able to stabilize a small preterm infant with CPAP, how should you maintain it while you are transferring the baby to the NICU? This study was stopped early as there was no difference between groups, i think that makes sense as long as you are careful  to maintain distending pressure, it doesn’t matter very much how you do it during the transition period.

McCarthy LK, Twomey AR, Molloy EJ, Murphy JFA, O’Donnell CPF: A Randomized Trial of Nasal Prong or Face Mask for Respiratory Support for Preterm Newborns. Pediatrics 2013, 132(2):e389-e395. This is a similar trial looking at how to give distending pressure in the delivery room, again showing that it doesn’t matter much, as long as you are careful to ensure that there is real positive pressure being delivered.

So if your very premature baby can avoid intubation, giving CPAP by either a face mask or a single nasal tube are equally effective, you just need to ensure that you have procedures in place to provide uninterrupted distending pressure during the transfer to the NICU, and starting CPAP once you are there.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , , . Bookmark the permalink.

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