Nasal CPAP or intubation at birth for very preterm infants
Nasal CPAP or intubation at birth for very preterm infants
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DOI：
10.1056/nejmoa072788
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发表时间：
2008-02-14
影响因子：
158.5
通讯作者：
Carlin, John B.
中科院分区：
文献类型：
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作者：
Morley, Colin J.;Davis, Peter G.;Carlin, John B.
背景：支气管肺发育不良与呼吸机和氧气治疗有关。这项随机试验旨在探讨出生后不久经鼻持续正压通气(CPAP)是否能降低早产儿死亡率或支气管肺发育不良的发生率。方法：将610名胎龄25~28周的早产儿随机分为CPAP组和出生后5分钟插管及呼吸机组。结果：在胎龄36周时，接受CPAP治疗的307名婴儿中有33.9%死亡或出现支气管肺发育不良，而接受插管治疗的303名婴儿中有38.9%死亡或出现支气管肺发育不良(支持CPAP的优势比为0.80；95%可信区间[CI]为0.58至1.12；P=0.19)。28天时，CPAP组死亡或需氧疗的风险低于插管组(优势比为0.63；95%可信区间为0.46~0.88；P=0.006)。总体死亡率几乎没有差异。在CPAP组，46%的婴儿在前5天内插管，表面活性物质的使用减少了一半。CPAP组气胸发生率为9%，插管组为3%(P
Background: Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would reduce the rate of death or bronchopulmonary dysplasia in very preterm infants.Methods: We randomly assigned 610 infants who were born at 25-to-28-weeks' gestation to CPAP or intubation and ventilation at 5 minutes after birth. We assessed outcomes at 28 days of age, at 36 weeks' gestational age, and before discharge.Results: At 36 weeks' gestational age, 33.9% of 307 infants who were assigned to receive CPAP had died or had bronchopulmonary dysplasia, as compared with 38.9% of 303 infants who were assigned to receive intubation (odds ratio favoring CPAP, 0.80; 95% confidence interval [CI], 0.58 to 1.12; P=0.19). At 28 days, there was a lower risk of death or need for oxygen therapy in the CPAP group than in the intubation group (odds ratio, 0.63; 95% CI, 0.46 to 0.88; P=0.006). There was little difference in overall mortality. In the CPAP group, 46% of infants were intubated during the first 5 days, and the use of surfactant was halved. The incidence of pneumothorax was 9% in the CPAP group, as compared with 3% in the intubation group (P