Breathing Life into Little Lungs

CPAP treatment for extreme preemies just as effective as other breathing treatment

(RxWiki News) Babies born extremely early often need extra help breathing because their lungs haven't fully developed. Now doctors understand how the two ways currently used to do that affect the children later on.

The traditional method has been to put the babies on a ventilator after giving them a sticky substance, called surfactant, to coat the inside of their lungs.

Surfactant is produced naturally in the lungs by humans, but the lungs of premature babies usually have not begun to produce it yet.

A new method is to use continuous positive airway pressure (CPAP). CPAP pushes air into the nasal passages. It is usually used to treat a condition called sleep apnea.

A recent study has shown that children who received CPAP therapy did just as well over a year later as children who received the usual treatment. Those receiving a higher level of oxygen did a little better than those getting a lower level.

"Attend all prenatal appointments."

The study, led by Yvonne E. Vaucher, MD, MPH, from the Department of Pediatrics at the University of California at San Diego, was a follow-up study from an earlier one comparing very early preemies who received oxygen through CPAP and those who received it through the ventilator.

The 1,234 babies in the study had all been born between 24 weeks and 28 weeks of pregnancy. In addition to the differences between CPAP use and ventilator use, the children in the study received either lower blood oxygen saturation levels of 85 to 89 percent or higher levels of 91 to 95 percent.

The first study found that babies receiving more oxygen were more likely to survive but also more likely to experience retinopathy, an eye condition that can lead to blindness. It also found both CPAP and ventilator use worked equally well for the babies.

The current study followed up with the same babies 18 to 22 months after the babies normally would have been born. A total of 1,058 babies had survived, and 990 of them were evaluated.

Overall, 28 percent of the babies in the CPAP group and 30 percent of the babies in the surfactant/ventilator group had died or else developed a serious neurodevelopmental condition, such as cerebral palsy, blindness, deafness or low motor development and mental scores for their age.

In terms of oxygen saturation, 30 percent of the babies receiving the lower oxygen saturation and 28 percent of the ones receiving the higher saturation died or had a neurodevelopmental condition. The differences in both these measures was not large enough to be considered significant.

When the researchers looked only at infants' deaths, excluding neurodevelopmental issues, they found that 22 percent of the babies receiving less oxygen had died, compared to 18 percent of those receiving more oxygen.

This difference may be just barely large enough to be significant, revealing that higher oxygen saturation led to a slightly lower mortality (death) rate.

The researchers also found that the children receiving more oxygen were more likely to have received corrective eye surgery by the time of follow-up, but there was no difference in vision problems between the two groups.

Ultimately, this means that treatment with surfactant and a ventilator and treatment with CPAP are both just as effective for babies in the short term and long term. Treatment with higher oxygen levels appears to offer a slightly better survival rate compared to treatment with lower oxygen levels.

The study was published December 27 in the New England Journal of Medicine. The researched was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute.

Reviewed by: 
Review Date: 
January 10, 2013