CORSAD RCT RESULTS: Do Preterm Nasal Prongs Rather than Facemasks in the Delivery Room Reduce Preterm Infant Deaths?
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
Unblinded randomized clinical trial
Comparison of Respiratory Support After Delivery on Infants Born Before 28 Weeks Gestational Age (CORSAD) trial
Liveborn infants delivered <28 of gestation
New respiratory support system with short binasal prongs
Standard T-piece system with face mask
Both interventions provided CPAP for 10 to 30 minutes, and positive pressure ventilation, if needed
Delivery room intubation or death within 30 minutes of birth
Respiratory and safety variables
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
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
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