Background: Early use of Continuous Positive Airway pressure (CPAP) is feasible and is associated with decreased chronic lung disease. However, avoiding intubation in the delivery room (DR) denies the early administration of surfactant in these infants. It is not clear whether the practice of DR intubation of infants at limits of viability (Gestational age (GA) < 25 weeks) would improve their outcomes. Objectives: To examine the feasibility of the use of CPAP in the DR for infants with GA < 25 weeks, and to test the success of CPAP in the first 3 days of life in this population. Methods: We reviewed data on VLBW ( < 1500g) infants born in January 2005 through December 2015. These infants were managed with bubble CPAP with the intention to avoid intubation in DR. Surviving infants were stratified into four groups based on the combination of DR intubation and being intubated at 3 days of life. Grp 1: intubated in DR and continued intubation through day 3, Grp 2: intubated in DR but extubated before 3 days, Grp 3: managed with CPAP in DR but intubated by day 3, and Grp 4: managed with CPAP in DR and through day 3. Results: A total of 461 infants were reviewed; of them 47, 76, 40, and 298 infants were in Grps 1-4. GA (wks) for the groups were 25.2±2.7, 26.4±2.4, 26.8±3.1, and 29.4±2.8, respectively. BW (g) for the groups were 693±272, 861±268, 869±283, and 1136±282, respectively. Group assignments by GA are presented in figure 1. Infants who were never intubated in DR or during the first 3 days of life constituted 24% of the population < 24 weeks, 17% of 24 wks, 38% of 25-26 weeks, and 72% of 27-28 weeks. Conclusions: Although the majority of infants with GA ≥27 weeks were not intubated, almost ¾ of infants with GA ≤ 24 weeks were intubated within 72 hours of life. A clear algorithm for DR management needs to be specified for infants at the limits of viability. The benefits of avoiding DR intubation need to be further explored in this population.

Percent of infants failing initial CPAP for each gestational age category

Percent of infants failing initial CPAP for each gestational age category

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