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Randomized trial of early bubble continuous positive airway pressure for very low birth weight infants

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dc.contributor.author Tapia, J.L.
dc.contributor.author Urzua, S.
dc.contributor.author Bancalari, A.
dc.contributor.author Meritano, J.
dc.contributor.author Torres, G.
dc.contributor.author Fabres, J.
dc.contributor.author Toro, C.A.
dc.contributor.author Rivera, F.
dc.contributor.author Cespedes, E.
dc.contributor.author Burgos, J.F.
dc.contributor.author Mariani, G.
dc.contributor.author Roldan, L.
dc.contributor.author Silvera, F.
dc.contributor.author Gonzalez, Agustina
dc.contributor.author Dominguez, A.
dc.date.accessioned 2022-01-18T19:26:47Z
dc.date.available 2022-01-18T19:26:47Z
dc.date.issued 2012
dc.identifier.uri https://hdl.handle.net/20.500.12866/10878
dc.description.abstract Objective: To determine whether very low birth weight infants (VLBWIs), initially supported with continuous positive airway pressure (CPAP) and then selectively treated with the INSURE (intubation, surfactant, and extubation to CPAP; CPAP/INSURE) protocol, need less mechanical ventilation than those supported with supplemental oxygen, surfactant, and mechanical ventilation if required (Oxygen/mechanical ventilation [MV]). Study design: In a multicenter randomized controlled trial, spontaneously breathing VLBWIs weighing 800-1500 g were allocated to receive either therapy. In the CPAP/INSURE group, if respiratory distress syndrome (RDS) did not occur, CPAP was discontinued after 3-6 hours. If RDS developed and the fraction of inspired oxygen (FiO 2) was >0.35, the INSURE protocol was indicated. Failure criteria included FiO2 >0.60, severe apnea or respiratory acidosis, and receipt of more than 2 doses of surfactant. In the Oxygen/MV group, in the presence of RDS, supplemental oxygen without CPAP was given, and if FiO 2 was >0.35, surfactant and mechanical ventilation were provided. Results: A total of 256 patients were randomized to either the CPAP/INSURE group (n = 131) or the Oxygen/MV group (n = 125). The need for mechanical ventilation was lower in the CPAP/INSURE group (29.8% vs 50.4%; P =.001), as was the use of surfactant (27.5% vs 46.4%; P =.002). There were no differences in death, pneumothorax, bronchopulmonary dysplasia, and other complications of prematurity between the 2 groups. Conclusion: CPAP and early selective INSURE reduced the need for mechanical ventilation and surfactant in VLBWIs without increasing morbidity and death. These results may be particularly relevant for resource-limited regions. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Journal of Pediatrics
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject female en_US
dc.subject article en_US
dc.subject controlled study en_US
dc.subject major clinical study en_US
dc.subject priority journal en_US
dc.subject morbidity en_US
dc.subject mortality en_US
dc.subject infant en_US
dc.subject oxygen en_US
dc.subject multicenter study en_US
dc.subject randomized controlled trial en_US
dc.subject artificial ventilation en_US
dc.subject positive end expiratory pressure en_US
dc.subject prematurity en_US
dc.subject treatment outcome en_US
dc.subject clinical assessment en_US
dc.subject bradycardia en_US
dc.subject steroid en_US
dc.subject oxygen therapy en_US
dc.subject steroid therapy en_US
dc.subject clinical protocol en_US
dc.subject oxygen supply en_US
dc.subject very low birth weight en_US
dc.subject apnea en_US
dc.subject endotracheal intubation en_US
dc.subject extubation en_US
dc.subject fraction of inspired oxygen en_US
dc.subject inspiratory capacity en_US
dc.subject lung dysplasia en_US
dc.subject lung surfactant en_US
dc.subject neonatal respiratory distress syndrome en_US
dc.subject peak inspiratory flow en_US
dc.subject pneumothorax en_US
dc.title Randomized trial of early bubble continuous positive airway pressure for very low birth weight infants en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.jpeds.2011.12.054
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.03
dc.relation.issn 1097-6833


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