BACKGROUND AND PURPOSE:

• Stabilization of extreme preterm infant breathing in the delivery room has become less invasive, moving from mechanical ventilation to CPAP with positive pressure ventilation by mask
• Current breathing systems may have negative effects
  • Infants experience significant work of breathing through the mask system
  • Mask itself may result in apnea or bradycardia (trigeminocardiac reflex)
• Donaldsson et al. (JAMA Pediatr, 2021) determined whether using a respiratory support system with low imposed work of breathing with short binasal prongs decreases delivery room intubations or death compared with a standard T-piece system with a face mask

METHODS:

• Unblinded randomized clinical trial
  • Comparison of Respiratory Support After Delivery on Infants Born Before 28 Weeks Gestational Age (CORSAD) trial
• Participants
  • Liveborn infants delivered <28 of gestation
• Interventions
  • New respiratory support system with short binasal prongs
  • Standard T-piece system with face mask
• Study design
  • Both interventions provided CPAP for 10 to 30 minutes, and positive pressure ventilation, if needed
• Primary outcome
  • Delivery room intubation or death within 30 minutes of birth
• Secondary outcomes
  • Respiratory and safety variables

RESULTS:

• 246 liveborn infants
  • New system: 127 infants | Old system: 123 infants
  • Mean (SD) age:  25.9 (1.3) weeks
• Infants intubated or died in the delivery room
  • New support system: 33.1%
  • Standard system: 45.1%
  • Adjusted Odds Ratio (aOR) 0.53 (95% CI, 0.30 to 0.94); P=0.03
• There were no significant differences in secondary outcomes or safety variables

CONCLUSION:

• A new nasal prong system that replaced face masks and reduced infant work of breathing resulted in fewer delivery room intubations or deaths of extremely preterm infants
• The authors state

We believe that the statistically significant decrease in intubations in our trial is important for this population of extremely preterm infants

Intubation and mechanical ventilation are major risk factors for later pulmonary morbidity, and delaying or eliminating these interventions is crucial 

Learn More – Primary Sources:

Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks’ Gestational Age

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Cochrane Update: Antenatal Corticosteroids and Impact on Respiratory Morbidity or Death in Preterm Births

Fetal Lung Mass – Best Predictors of Newborn Respiratory Distress?

Is Labor Independently Associated with Reduced Neonatal Respiratory Complications?