Affiliations: Division of Neonatology, Department of Pediatrics,
Medical University of Graz, Graz, Austria | Neonatal Services, Royal Women's Hospital, Melbourne,
Australia | Murdoch Children's Research Institute, Melbourne,
Australia | Department of Physiology, Monash University,
Melbourne, Australia
Note: [] Corresponding author: Professor Friedrich Reiterer, MD, Division
of Neonatology, Department of Pediatrics, Medical University of Graz,
Auenbruggerplatz 30, 8036 Graz, Austria. Tel.: +43 316 385 84558; Fax: +43 316
385 2678; E-mail: [email protected]
Abstract: Aims: To study incidence and type of pulmonary air leak in preterm
infants with respiratory distress treated with early nasal continuous positive
airway pressure (NCPAP) and to assess risk factors for NCPAP-failure. Methods: A prospective, observational, single center study from August 2007 to
November 2008. Early NCPAP using Infant Flow CPAP
system® was started in patients with a
median (range) postnatal age of 1.47 (0.5–11) hours. A written NCPAP protocol
including chest x-ray was applied to detect early signs of air leak.
Babies were intubated when their FiO_{2} requirements were
> 0.35. Results: 54 neonates, 45 with respiratory distress syndrome
and 9 with transient tachypnea of the newborn, were studied with a gestational
age of 33.6 ± 1.1 weeks and a birthweight of 2026 ± 303 gm (mean ±
SD). A total of five infants had air leak (9.3%), one of them developed
pneumothorax (1.8%) and four infants had transient pulmonary interstitial
emphysema (7.4%). NCPAP- failure rate was 48.1%. The single case with
pneumothorax was discovered only after being intubated and surfactant was
administered. Conclusion: Early NCPAP/low threshold rescue surfactant
policy in preterm infants ⩾ 32 weeks of gestation with respiratory
distress was associated with a 9.3% incidence of air leak, mainly in the
form of pulmonary interstitial emphysema. Clinical variables significantly
associated with NCPAP- failure were RDS and early onset sepsis.
