563 - Delivery room management does not predict CPAP failure in extreme preterm infants

Poster Number: 563
Publication Number: 563.3031

Background: To decrease the risk for BPD in extreme preterm infants, the guidelines on neonatal resuscitation from the American Heart Association are suggesting a trial of CPAP in the delivery room instead of routine intubation and surfactant application. Extreme preterm infants who fail CPAP within the first days after birth have a higher risk for neonatal morbidity and mortality.

Objective: To compare delivery room management of extreme preterm infants who were stabilized on CPAP in the DR and remained on noninvasive respiratory support (“CPAP success”) to infants who required intubation and surfactant within the first 96 hours after birth (“CPAP failure”)

Design/Methods: This retrospective study compared two groups of preterm infants born < 29 weeks gestation at birth who were stabilized in the DR on CPAP without surfactant application and admitted to a level IV NICU between 2016 and 2021: infants with CPAP success and infants with CPAP failure. Data including maternal and neonatal characteristics, delivery room management, neonatal morbidity and mortality were collected from the electronic medical record and compared between the two groups.

Results: 121 preterm infants < 29 weeks were stabilized in the DR on CPAP without surfactant application: 72 had CPAP success and 49 experienced CPAP failure. Although there was no difference in gestational age, infants with CPAP success had a higher birth weight (1050 vs 1010g, p< 0.04). Compared to CPAP failure, CPAP success was associated with preterm labor, vaginal delivery and exposure to antenatal magnesium (all p< 0.01). Maternal antenatal steroid, delayed cord clamping, PPV in the DR, Apgar, HR, FiO2 and SpO2 at 5 min, CPAP pressure and FiO2 on NICU admission were not different between the 2 groups. Compared to CPAP success, a higher percentage of infants with CPAP failure required postnatal dexamethasone (22.4 vs 4.2%); had moderate or severe BPD at 36 weeks (62.2 vs 31.9%); had ROP requiring treatment (8% vs 0), required oxygen at discharge (26.2 vs 8.3%) or died before discharge (14.3% vs 0) (all p< 0.01).

Conclusion(s): In this study, delivery room management for infants with CPAP success was not different compared to infants with CPAP failure. In contrast, maternal factors as preterm labor, hypertensive disorder, exposure to magnesium sulfate and mode of delivery affected CPAP failure significantly. CPAP failure was associated with mortality, respiratory morbidity and prolonged hospitalization. Newer, less invasive methods to administer surfactant to spontaneously breathing infants may decrease the rate of CPAP failure.