Delivery Room CPAP in Extremely Low Birth Weight Infants

Previous studies suggested that early continuous airway positive pressure (CPAP) may be
beneficial in reducing ventilator dependence and subsequent bronchopulmonary dysplasia (BPD)
in extremely low birth weight (ELBW) infants. These studies did not test for the optimal
timing of CPAP initiation or compare CPAP/PEEP initiation in the delivery room against
standard resuscitation methods. Current practice at the time was for the ELBW infant to be
intubated early and administered prophylactic surfactant. The feasibility of initiating CPAP
in the DR and continuing this therapy without intubation for surfactant had not been
determined prospectively in a population of ELBW infants.

This pilot study was designed to determine the feasibility of randomizing extremely low birth
weight (ELBW) infants <28 weeks' gestation who required resuscitation to one of two
resuscitation methods, either: (a) 100% oxygen by facemask and continuous positive airway
pressure (CPAP) or positive pressure ventilation (PPV) with positive end-expiratory pressure
(PEEP), if the infant required PPV (the intervention group); or (b) 100% oxygen and no CPAP
and no PEEP if the infant required PPV (the control group).

Inclusion Criteria:

- Infants delivered in a specially equipped resuscitation room(s)

- <28 weeks gestational age by best obstetric estimate before delivery

- Requiring resuscitation

Exclusion Criteria:

- No known major congenital anomalies

- Decision made not to provide full resuscitation