Continuous positive airway pressure in delivery room in extremely preterm infants: A single‐center retrospective study in China

TL;DR

This study examines whether using continuous positive airway pressure in the delivery room helps extremely preterm infants in China by reducing the need for tracheal intubation.

Contribution

The study provides a single-center retrospective analysis of DRCPAP effects in extremely preterm infants in China, a context with limited prior research.

Findings

DRCPAP initially showed a reduced intubation rate compared to the control group.

After propensity score matching, no significant difference in intubation rates was observed between DRCPAP and control groups.

The study highlights the need for further investigation into DRCPAP's effectiveness in reducing intubation rates in extremely preterm infants.

Abstract

To assess the beneficial effects of delivery room continuous positive airway pressure (DRCPAP) in extremely preterm infants, a single‐center retrospective study was performed at the Women and Children's Hospital of Chongqing Medical University in China. Infants born between January 2016 and December 2018 were regarded as the control group, and those born between January 2019 and August 2022 were considered as the observation group (DRCPAP group). The primary outcome was tracheal intubation within 72 h after birth. Six hundred and seven patients were included in the study (control: 232; DRCPAP: 375). Compared with the control group, DRCPAP reduced the intubation rate (56.8% vs. 62.9%, OR 0.57, 95% CI 0.34–0.96, p = 0.035), including <28 weeks gestational age (GA) subgroup (61.5% vs. 84.7%, OR 0.12, 95% CI 0.02–0.78, p = 0.027). One‐to‐one propensity score matching (195:195) was used to match the baseline characteristics of patients in DRCPAP and control group. After matching, no significant differences were observed in intubation rate within 72 h between the two groups (20.5% [40 of 195] vs. 22.1% [43 of 195]; p = 0.711). Whether DRCPAP can reduce intubation rate within 72 h requires further investigation.

In extremely preterm infants, nasal continuous positive airway pressure in the delivery room is recommended at the beginning of respiratory support to maintain functional residual volume, improve lung compliance, and increase oxygenation. However, when used in developing nations, these high‐quality studies from developed nations revealed some different results, such as failing to reduce the rate of mechanical ventilation and having a higher risk of pneumothorax. Also, no literature reports of large samples were reported in China, and we carried out this single‐center retrospective investigation to compare the short‐term outcomes of extremely preterm infants before and after the introduction of DRCPAP. To assess the beneficial effects of delivery room continuous positive airway pressure (DRCPAP) in extremely preterm infants.

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