• Arjan B te Pas, Vivian M Spaans, Monique Rijken, Colin J Morley, and Frans J Walther.
• Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.b.te_pas@lumc.nl
• Acta Paediatr. 2008 Aug 1; 97 (8): 1049-54.

AimTo determine if selective intubation, use of early nasal continuous positive airway pressure (NCPAP) at birth with a low threshold for early surfactant treatment, reduces the need for intubation in very preterm infants in the first days after birth.MethodsTwo cohorts of very preterm infants < or = 32 weeks, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (1996-1997) and after (2003-2004) introducing selective intubation and use of early NCPAP. A FiO(2)> or = 0.40 was used as criterion for intubation. Primary outcome measure was intubation < 72 h of age. Bronchopulmonary dysplasia (BPD) was a secondary outcome.ResultsThe rate of intubation in the delivery room (69% vs. 46%, p < 0.001) and within 72 h of age (73% vs. 57%, p < 0.001) was lower following the change in policy. Early NCPAP was, in 2003-2004, increasingly used as primary treatment (10% vs. 33%, p < 0.001) with higher maximum NCPAP levels (4.0 (0.9) vs. 5.8 (1.5), p < 0.001). There was no change in BPD (14.3% vs. 15.2%, p = 0.82).ConclusionAvoiding intubation by using early NCPAP while maintaining a low-threshold for surfactant treatment decreased the need for intubation.

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