Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age

• Published in: Journal of perinatology Vol. 42; no. 6; pp. 761 - 768
• Main Authors: Stocks, Edward F., Jaleel, Mambarambath, Smithhart, William, Burchfield, Patti J., Thomas, Anita, Mangona, Kate Louise M., Kapadia, Vishal, Wyckoff, Myra, Kakkilaya, Venkatakrishna, Brenan, Shelby, Brown, L. Steven, Clark, Christopher, Nelson, David B., Brion, Luc P.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-06-2022; Nature Publishing Group
• Subjects: 692/700/1720; 692/700/565; Continuous positive airway pressure; Continuous Positive Airway Pressure - adverse effects; Cyanosis; Delivery Rooms; Electronic health records; Female; Gestational Age; Humans; Infant, Newborn; Intervention; Medicine; Medicine & Public Health; Neonates; Newborn babies; Nurse practitioners; Pediatric Surgery; Pediatrics; Pneumothorax; Pneumothorax - etiology; Pregnancy; Premature babies; Respiration; Respiratory Distress Syndrome, Newborn - therapy; Resuscitation; Retrospective Studies; Subgroups; Ventilators
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-022-01334-4

Objective
We previously reported an increase in pneumothorax after implementing delivery room (DR) continuous positive airway pressure (CPAP) for labored breathing or persistent cyanosis in ≥35-week gestational age (GA) neonates unexposed to DR-positive pressure ventilation (DR-PPV). We hypothesized that pneumothorax would decrease after de-implementing DR-CPAP in those unexposed to DR-PPV or DR-O
2
supplementation (DR-PPV/O
2
).
Study design
In a retrospective cohort excluding DR-PPV the primary outcome was DR-CPAP-related pneumothorax (1st chest radiogram, 1st day of life). In a subgroup treated by the resuscitation team and admitted to the NICU, the primary outcome was DR-CPAP-associated pneumothorax (1st radiogram, no prior PPV) without DR-PPV/O
2
.
Results
In the full cohort, occurrence of DR-CPAP-related pneumothorax decreased after the intervention (11.0% vs 6.0%,
P
 < 0.001). In the subgroup, occurrence of DR-CPAP-associated pneumothorax decreased after the intervention (1.4% vs. 0.06%,
P
 < 0.001).
Conclusion
The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O
2
.