TY - JOUR
T1 - Delivery room continuous positive airway pressure and pneumothorax
AU - Smithhart, William
AU - Wyckoff, Myra H.
AU - Kapadia, Vishal
AU - Jaleel, Mambarambath
AU - Kakkilaya, Venkatakrishna
AU - Brown, L. Steven
AU - Nelson, David B.
AU - Brion, Luc P.
N1 - Publisher Copyright:
© 2019 by the American Academy of Pediatrics
PY - 2019
Y1 - 2019
N2 - BACKGROUND: In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS: We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS: In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P, .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P, .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P, .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P, .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS: The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.
AB - BACKGROUND: In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS: We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS: In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P, .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P, .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P, .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P, .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS: The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.
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U2 - 10.1542/peds.2019-0756
DO - 10.1542/peds.2019-0756
M3 - Article
C2 - 31399490
AN - SCOPUS:85071786000
SN - 0031-4005
VL - 144
JO - Pediatrics
JF - Pediatrics
IS - 3
M1 - 20190756
ER -