Provision of bubble continuous positive airway pressure for the stabilisation of extremely and very preterm infants after birth: A single‐centre experience

Abstract

AimTo describe the effect of resuscitation with bubble CPAP (bCPAP) versus T‐piece device at birth on early clinical parameters and hospital outcomes in infants born <32 weeks gestation.MethodsThis is a single‐centre pre‐ and post‐implementation study comparing outcomes in two epochs. In epoch 1 (1 July 2013–31 December 2014), infants were managed with non‐humidified gas using Neopuff® T‐piece devices to support breathing after birth. In epoch 2 (1 March 2020–31 December 2021), routine application of bCPAP with humidified gas was introduced at birth.ResultsThree hundred fifty‐seven patients were included (176 epoch 1, 181 epoch 2). The mean gestational age was 28 ± 2 weeks. The demographics of the two epochs were comparable. There were significant improvements in outcomes of infants in epoch 2 with less infants intubated at delivery (16% vs. 4%, P ≤ 0.001), improved 5 min Apgar (7 vs. 8, P ≤ 0.001), reduced need for ventilation (21% vs. 8.8%, P ≤ 0.001), duration of ventilation in the first 72 h (9.6 vs. 4.6 h) and mortality (10.8% vs. 1.7%, P ≤ 0.001). There was, increased incidence of chronic lung disease (30% vs. 55%, P = 0.02) but no increase in infants discharged on oxygen (3.8% vs. 5%, P = 0.25). Similar findings were observed in a subgroup of infants born <25 weeks' gestation with no increase in the incidence of CLD.ConclusionIntroducing application of bCPAP from the first breaths in infants <32 weeks' gestation was associated with better short‐term outcomes and mortality, albeit with increased incidence of CLD. The subgroup of infants born <25 weeks' gestation showed similar change in outcomes, with no increase in CLD.