[Prophylactic CPAP versus therapeutic CPAP in preterm newborns of 28-32 gestational weeks].

UNLABELLED: Strategies in ventilation and in exposure to the oxygen that minimise lung injury improved the prognosis of the extremely low weight newborns. Avoiding intubation can prevent the reduction of mucociliary flow, injury of the mucosa and infection. Using early CPAP isn't unanimous; there are differences between studies in what are concerned: the beginning of the treatment, gestational age, methods. CPAP is used in the treatment of respiratory arrest of infants since 1971, initially endotracheal, than with different nasal instruments. The studies evaluate the benefits of prophylactic or curative CPAP.

OBJECTIVES: To compare the necessity for mechanical ventilation and surfactant administration, complications and the period of hospitalisation in VLBW and ELBW, that were under prophylactic or curative CPAP.

MATERIAL AND METHOD: We made a prospective study on 90 newborns, during january 2004 and june 2006, that were not intubated in the delivery room with no major malformations. Preventive CPAP was applied in the first half an hour after birth. therapeutical CPAP was applied only in infants with the necessity in oxygen over 40%, to maintain the saturation between 90 - 95%. Group A (curative CPAP) - 25 cases, the average for gestational age 30,30+/-2,45 weeks and for birth weight 1588,00+/-573,05. For group B the averages were: 30,08+/-2,30 weeks and 1508,50+/-400,83 grams.

RESULTS: Surfactant was necessary in 40% of group A, over 23% in group B (p = 0,269). Mechanical ventilation in first 72 hours of life was necessary in 18 cases (72%) - A and in 35 cases (53,84%) - B. The necessity for CPAP in hours: 92,15+/-3,85 in group A, over 112,25+/-5,75 group B (p = 0,044). Complications we considered: PDA and cerebral hemorrhage. We had 8 cases (38%) of group A with PDA, significantly different of group B: 5 cases (7,69%). Cerebral hemorrhage was absent in 40% of group A and in 73,84% in group B (p = 0,11).

CONCLUSIONS: CPAP is a non invasive method with benefits in the treatment of the respiratory arrest in preterm newborn of 28 - 32 gestational weeks. Using early CPAP may reduce: necessity for surfactant, mechanical ventilation and PDA.