Modalities in the management of respiratory distress syndrome in neonates has revolutionized neonatal care. Mechanical ventilation, state of art monitoring in NICU has improved outcomes in these babies. Surfactant replacement therapy has been the Landmark discovery in this field. Besides Hyaline membrane disease, surfactant is also being studied in other respiratory disorders like meconium aspiration syndrome, pneumonia and pulmonary hemorrhage, but still remains experimental. Further progress in the treatment of neonatal RDS may include “ designer ” surfactant preparations (<xref ref-type="bibr" rid="bib001">1</xref>). Gradually the field of neonatology is moving away from intubation and mechanical ventilation with more aggressive use of nasal CPAP.A recent review published in <italic>Arch Dis Child Fetal Neonatal Ed. 2003 May; 88(3): F168-72</italic><bold> Nasal CPAP for neonates: what do we know in 2003</bold>? (full article available on line) has looked into the current aspects of nasal CPAP. Despite the acknowledged clinical usefulness of nasal CPAP, uncertainties regarding aspects of its application remain. Clinical indications for the application of nasal CPAP vary greatly between institutions. Furthermore, defining the optimal nasal CPAP system is complicated by the multiplicity of nasal CPAP devices and techniques available to the clinician. This review tries to identify what we know about nasal CPAP and what important questions remain.Another article titled <bold><italic>Early bubble CPAP and outcomes in ELBW preterm infantspublished in J Perinatal 2003 Apr-May; 23(3): 195–9.</italic></bold>Has depicted an attempt to test whether the introduction of early bubble continuous positive airway pressure (CPAP) results in improved respiratory outcomes in extremely low birth-weight infants. Delivery room intubations, days on mechanical ventilation and use of postnatal steroids decreased (p<0.001), while mean days on CPAP, number of babies on CPAP at 24 hours (p<0.001) and mean weight at 36 weeks corrected gestation also increased (p<0.05) after introduction of early bubble CPAP. This study concludes that early bubble CPAP reduced delivery room intubations, days on mechanical ventilation, postnatal steroid use and was associated with increased postnatal weight gain with no increased complications.<bold>Cochrane database regarding Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants</bold> has shown that Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population. The objective of this review is to find out that preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen? MAIN RESULTS: Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support [RR 0.62 (0.49,0.77), RD −0.17 (−0.24, −0.10),NNT 6 (4,10)].</sec><sec id="sec001"><title>Reviewer’s Conclusions

JNNFI

Journal of Neonatology

0973-21870973-2179

National Neonatology Forum

jn-17-4-010

Online Neonatology

CPAP in neonates: Selected reviews

Saluja

Satish

Dr.

Division of Neonatology, Dept. of Pediatrics, Sir Ganga Ram Hospital, Old Rajindera Nagar New Delhi-110 060

10–122003

1746667

Modalities in the management of respiratory distress syndrome in neonates has revolutionized neonatal care. Mechanical ventilation, state of art monitoring in NICU has improved outcomes in these babies. Surfactant replacement therapy has been the Landmark discovery in this field. Besides Hyaline membrane disease, surfactant is also being studied in other respiratory disorders like meconium aspiration syndrome, pneumonia and pulmonary hemorrhage, but still remains experimental. Further progress in the treatment of neonatal RDS may include “ designer ” surfactant preparations (<xref ref-type="bibr" rid="bib001">1</xref>). Gradually the field of neonatology is moving away from intubation and mechanical ventilation with more aggressive use of nasal CPAP.A recent review published in <italic>Arch Dis Child Fetal Neonatal Ed. 2003 May; 88(3): F168-72</italic><bold> Nasal CPAP for neonates: what do we know in 2003</bold>? (full article available on line) has looked into the current aspects of nasal CPAP. Despite the acknowledged clinical usefulness of nasal CPAP, uncertainties regarding aspects of its application remain. Clinical indications for the application of nasal CPAP vary greatly between institutions. Furthermore, defining the optimal nasal CPAP system is complicated by the multiplicity of nasal CPAP devices and techniques available to the clinician. This review tries to identify what we know about nasal CPAP and what important questions remain.Another article titled <bold><italic>Early bubble CPAP and outcomes in ELBW preterm infantspublished in J Perinatal 2003 Apr-May; 23(3): 195–9.</italic></bold>Has depicted an attempt to test whether the introduction of early bubble continuous positive airway pressure (CPAP) results in improved respiratory outcomes in extremely low birth-weight infants. Delivery room intubations, days on mechanical ventilation and use of postnatal steroids decreased (p<0.001), while mean days on CPAP, number of babies on CPAP at 24 hours (p<0.001) and mean weight at 36 weeks corrected gestation also increased (p<0.05) after introduction of early bubble CPAP. This study concludes that early bubble CPAP reduced delivery room intubations, days on mechanical ventilation, postnatal steroid use and was associated with increased postnatal weight gain with no increased complications.<bold>Cochrane database regarding Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants</bold> has shown that Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population. The objective of this review is to find out that preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen? MAIN RESULTS: Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support [RR 0.62 (0.49,0.77), RD −0.17 (−0.24, −0.10),NNT 6 (4,10)].</sec><sec id="sec001"><title>Reviewer’s Conclusions

Implications for practice: nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV.

References1De Paoli

Morley

Davis

. Nasal CPAP for neonates: what do we know in 2003? Arch Dis Child Fetal Neonatal Ed.2003May; 88(3): F168–72. Review.2Narendran

Donovan

Hoath

Akinbi

Steichen

Jobe

. Early bubble CPAP and outcomes in ELBW preterm infants. J Perinatol. 2003; 23 (3): 195–9.3Davis

Henderson-Smart

. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev.. 2003; (2): CD000143.