University of Texas Southwestern Medical Center, Dallas, TX, USA.
Oklahoma University, Norman, OK, USA.
J Perinatol. 2022 Jun;42(6):761-768. doi: 10.1038/s41372-022-01334-4. Epub 2022 Feb 16.
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 supplementation (DR-PPV/O).
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.
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).
The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O.
我们之前报道了在对≥35 周胎龄（GA）无 DR 正压通气（DR-PPV）暴露的有呼吸窘迫或持续性发绀的新生儿实施产房（DR）持续气道正压通气（CPAP）后，气胸发生率增加。我们假设在未接受 DR-PPV 或 DR-O 补充（DR-PPV/O）的情况下，停止 DR-CPAP 后气胸会减少。
在排除 DR-PPV 的回顾性队列中，主要结局是 DR-CPAP 相关气胸（第 1 张胸片，出生后第 1 天）。在由复苏团队治疗并收治新生儿重症监护病房（NICU）的亚组中，主要结局是无 DR-PPV/O 的 DR-CPAP 相关气胸（第 1 张胸片，无先前的 PPV）。
在全队列中，干预后 DR-CPAP 相关气胸的发生率降低（11.0% vs. 6.0%，P<0.001）。在亚组中，干预后 DR-CPAP 相关气胸的发生率降低（1.4% vs. 0.06%，P<0.001）。
在避免≥35 周 GA 新生儿使用 DR-CPAP 且无 DR-PPV/O 的情况下，CPAP 相关气胸的发生率降低。
