• Amer Ammari, Mandhir Suri, Vladana Milisavljevic, Rakesh Sahni, David Bateman, Ulana Sanocka, Carrie Ruzal-Shapiro, Jen-Tien Wung, and Richard A Polin.
• Division of Neonatology-Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York 10032-3702, USA.
• J. Pediatr. 2005 Sep 1;147(3):341-7.

ObjectiveTo identify risk factors and neonatal outcomes associated with the early failure of "bubble" nasal continuous positive airway pressure (CPAP) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS).Study DesignFollowing resuscitation and stabilization at delivery, a cohort of 261 consecutively inborn infants (birth weight < or = 1250 g) was divided into three groups based on the initial respiratory support modality and outcome at 72 hours of age: "ventilator-started" group, "CPAP-failure" group, and "CPAP-success" group.ResultsCPAP was successful in 76% of infants < or = 1250 g birth weight and 50% of infants < or = 750 g birth weight. In analyses adjusted for postmenstrual age (PMA) and small for gestational age (SGA), CPAP failure was associated with need for positive pressure ventilation (PPV) at delivery, alveolar-arterial oxygen tension gradient (A-a DO2) >180 mmHg on the first arterial blood gas (ABG), and severe RDS on the initial chest x-ray (adjusted odds ratio [95% CI] = 2.37 [1.02, 5.52], 2.91 [1.30, 6.55] and 6.42 [2.75, 15.0], respectively). The positive predictive value of these variables ranged from 43% to 55%. In analyses adjusted for PMA and severe RDS, rates of mortality and common premature morbidities were higher in the CPAP-failure group than in the CPAP-success group.ConclusionAlthough several variables available near birth were strongly associated with early CPAP failure, they proved weak predictors of failure. A prospective controlled trial is needed to determine if extremely premature spontaneously breathing infants are better served by initial management with CPAP or mechanical ventilation.

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