Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2002;2002(2):CD002975.
doi: 10.1002/14651858.CD002975.

Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants

J J Ho  1 , D J Henderson-Smart, P G Davis
Affiliations

Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants

J J Ho et al. Cochrane Database Syst Rev. 2002.

Update in

Abstract

Background: The application of a continuous distending pressure (CDP) has been shown to have some benefits in the treatment of pre-term infants with respiratory distress syndrome (RDS). CDP has the potential to reduce lung damage, particularly if applied early before atelectasis has occurred. Early application of CDP may better conserve an infant's own surfactant stores and consequently be more effective than CDP applied later in the course of RDS.

Objectives: In pre-term infants with RDS to determine if early compared with delayed initiation of CDP results in lower mortality and reduced need for intermittent positive pressure ventilation.

Search strategy: The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (Issue 1, 2002), MEDLINE (1966-2001), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.

Selection criteria: Trials among pre-term infants with respiratory distress syndrome spontaneously breathing at trial entry, which used random or quasi-random allocation to either early or delayed CDP.

Data collection and analysis: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by two authors.

Main results: In six studies on a total of 165 infants, early CDP was associated with a significant reduction in subsequent use of intermittent positive pressure ventilation, typical RR 0.55, RD -0.16, NNT 6, but there was no evidence of effect on overall mortality. There was no evidence of effect on the rates of pneumothorax (five studies) or bronchopulmonary dysplasia (one study). Early CDP resulted in a reduction in duration of oxygen therapy in the single study reporting this outcome.

Reviewer's conclusions: Early application of CDP has a clinical benefit in the treatment of RDS in that it reduces subsequent use of IPPV and thus may be useful in preventing the adverse effects of this treatment. However, many of the trials were done in the 1970s and 1980s and re-evaluation of the strategy of early CDP in the era of antenatal steroid use and early surfactant administration is indicated.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Early vs late CDP, Outcome 1 Use of IPPV.
1.2
1.2. Analysis
Comparison 1 Early vs late CDP, Outcome 2 Mortality (time not specified).
1.3
1.3. Analysis
Comparison 1 Early vs late CDP, Outcome 3 Mortality at 28 days.
1.4
1.4. Analysis
Comparison 1 Early vs late CDP, Outcome 4 Pneumothorax.
1.5
1.5. Analysis
Comparison 1 Early vs late CDP, Outcome 5 Duration of oxygen in survivors (days).
1.6
1.6. Analysis
Comparison 1 Early vs late CDP, Outcome 6 Use of IPPV below 1500 g.
1.7
1.7. Analysis
Comparison 1 Early vs late CDP, Outcome 7 Use of IPPV 1500 g or more.
1.8
1.8. Analysis
Comparison 1 Early vs late CDP, Outcome 8 Mortality (time not specified) below 1500 g.
1.9
1.9. Analysis
Comparison 1 Early vs late CDP, Outcome 9 Mortality (time not specified) 1500 g or more.
1.10
1.10. Analysis
Comparison 1 Early vs late CDP, Outcome 10 Bronchopulmonary dysplasia.
1.11
1.11. Analysis
Comparison 1 Early vs late CDP, Outcome 11 Retinopathy of prematurity.
2.1
2.1. Analysis
Comparison 2 Early vs late CDP ‐ excluding Krouskop 1975 (quasi‐random), Outcome 1 Use of IPPV.
2.2
2.2. Analysis
Comparison 2 Early vs late CDP ‐ excluding Krouskop 1975 (quasi‐random), Outcome 2 Mortality (time not specified).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Allen 1977 {published data only}
    1. Allen AP, Reynolds EOR, Rivers RPA, Souef PN, Wimberley PD. Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease. Archives of Disease in Childhood 1977;52:373‐8. - PMC - PubMed
Gerard 1975 {published data only}
    1. Gerard P, Fox WW, Outerbridge EW, Beaudry PH, Stern L. Early versus late introduction of continuous negative pressure in the management of the idiopathic respiratory distress syndrome. Journal of Pediatrics 1975;87:591‐5. - PubMed
Hegyi 1981 {published data only}
    1. Hegyi T, Hiatt IM. The effect of continuous positive airway pressure on the course of respiratory distress syndrome: The benefits of early initiation. Critical Care Medicine 1981;9:38‐41. - PubMed
Krouskop 1975 {published data only}
    1. Krouskop RW, Brown EG, Sweet AY. The early use of continuous positive airway pressure in the treatment of idiopathic respiratory distress syndrome. Journal of Pediatrics 1975;87:263‐6. - PubMed
Mockrin 1975 {published data only}
    1. Mockrin LD, Bancalari EH. Early versus delayed initiation of continuous negative pressure in infants with hyaline membrane disease. Journal of Pediatrics 1975;87:596‐600. - PubMed
Rowe 1978 {unpublished data only}
    1. Rowe JC, Guthrie RD, Hinkes P, Prueitt J, Murphy J, Woodrum DZ, Hodson WA. Time of initiation of CPAP in HMD (Abstract ). Pediatric Research 1978;12:533.

References to studies excluded from this review

John 1976 {published data only}
    1. John E, Thomas DB, Burnard ED. Influence of early introduction of continuous positive pressure breathing on the course of hyaline membrane disease. Australian Paediatric Journal 1976;12:276‐80. - PubMed
Tooley 2003 {published data only}
    1. Tooley J, Dyke M. Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome. Acta Paediatrica 2003;92:1170‐4. - PubMed

Additional references

Avery 1959
    1. Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. American Journal of Diseases of Children 1959;97:517. - PubMed
Bancalari 1992
    1. Bancalari E, Sinclair JC. Mechanical ventilation. In: Sinclair JC, Bracken MB editor(s). Effective Care of the Newborn Infant. Oxford: Oxford University Press, 1992:200‐20.
Barter 1960
    1. Barter RA, Maddison TG. The nature of the neonatal pulmonary hyaline membrane. Archives of Disease in Childhood 1960;25:460. - PMC - PubMed
Bell 1978
    1. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of Surgery 1978;187:1‐7. - PMC - PubMed
Cogswell 1975
    1. Cogswell JJ, Hatch DJ, Kerr AA. Effects of continuous positive airway pressure on lung mechanics of babies after operation for congenital heart disease. Archives of Disease in Childhood 1975;50:799‐804. - PMC - PubMed
Cotton 1980
    1. Cotton RB, Lindstrom DP, Kanarek KS, Sundell H, Stahlman MT. Effect of positive‐end‐expiratory‐pressure on right ventricular output in lambs with hyaline membrane disease. Acta Paediatrica Scandinavica 1980;69:603‐6. - PubMed
Cotton 1998
    1. Cotton RB. Pathophysiology of hyaline membrane disease (excluding surfactant). In: Polin RA, Fox WW editor(s). Fetal and Neonatal Physiology. 2nd Edition. Philadelphia: WB Saunders, 1998:1165‐74.
Davis 2003
    1. Davis PG, Henderson‐Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD000143] - DOI - PubMed
De Paoli 2003
    1. Paoli AG, Davis PG, Faber B, Morley CJ. Devices and pressure sources for administration of nasal continuous airway pressure (NCPAP) in preterm neonates. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD002977] - DOI - PubMed
Evans 1991
    1. Evans NJ, Archer LN. Doppler assessment of pulmonary artery pressure and extrapulmonary shunting in the acute phase of hyaline membrane disease. Archives of Disease in Childhood 1991;66:6‐11. - PMC - PubMed
Field 1985
    1. Field D, Milner AS, Hopkins EK. Effects of positive end expiratory pressure during ventilation of the preterm infant. Archives of Disease in Childhood 1985;60:21‐68. - PMC - PubMed
Gregory 1971
    1. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. New England Journal of Medicine 1971;284:1333‐40. - PubMed
Gribetz 1959
    1. Gribetz I, Frank NR, Avery ME. Static volume‐pressure relations of excised lungs of infants with hyaline membrane disease, newborn and stillborn infants. Journal of Clinical Investigation 1959;38:2168‐75. - PMC - PubMed
Harris 1996
    1. Harris TR, Wood ER. Physiologic principles. In: Goldsmith JP, Karotkin EH editor(s). Assisted ventilation. 3rd Edition. Philadelphia: WB Saunders, 1996:21‐68.
Herman 1973
    1. Herman S, Reynolds EOR. Methods of improving oxygenation in infants mechanically ventilated for severe hyaline membrane disease. Archives of Disease in Childhood 1973;48:612‐7. - PMC - PubMed
Ho 2002
    1. Ho JJ, Subramaniam P, Henderson‐Smart DJ, Davis PG. Continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD002271] - DOI - PubMed
Miller 1990
    1. Miller MJ, DiFiore JM, Strohl KP, Martin RJ. Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants. Journal of Applied Physiology 1990;68:141‐6. - PubMed
Narendran 2003
    1. Narendran V, Donovan EF, Hoath SB, Akinbi HT, Steichen JJ, Jobe AH. Early bubble CPAP and outcomes in ELBW preterm infants. Journal of Perinatology 2003;23:195‐9. - PubMed
Richardson 1978
    1. Richardson CP, Jung AL. Effects of continuous positive airway pressure on pulmonary function and blood gases of infants with respiratory distress syndrome. Pediatric Research 1978;12:771‐4. - PubMed
Saunders 1976
    1. Saunders RA, Milner AD, Hopkin IE. The effect of CPAP on lung mechanics and lung volumes in the neonate. Biology of the Neonate 1976;29:178‐81. - PubMed
Soll 2001
    1. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD000510] - DOI - PubMed
Verder 1994
    1. Verder H, Richardson B, Griesen G, Ebbesen F, Albertsen P, Lundstrom K, Jacobsen T. The Danish‐Swedish multicentre study group. Surfactant therapy and respiratory distress syndrome. New England Journal of Medicine 1994;331:1051‐5. - PubMed
Verder 1999
    1. Verder H, Albertson P, Ebbesen F, Griesen G, Robertson B, Bertelsen A, Agertoft L, Djernes B, Natha E, Reinholdt J. Nasal continuous positive pressure and early surfactant therapy for respiratory distress syndrome in newborns less than 30 weeks gestation. ePediatrics 1999;103:http//www.pediatrics.org/cgi/content/full/103/2/e24. - PubMed
Wyszogrodski 1975
    1. Wyszogrodski I, Kyei‐Aboagye K, Taeusch HW Jr, Avery ME. Surfactant inactivation by hyperventilation: conservation by end‐expiratory pressure. Journal of Applied Physiology 1975;38:461‐6. - PubMed
Yost 1999
    1. Yost CC, Soll RF. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database of Systematic Reviews 1999, Issue 4. [DOI: 10.1002/14651858.CD001456] - DOI - PubMed

References to other published versions of this review

Ho 2002b
    1. Ho JJ, Henderson‐Smart DJ, Davis PG. Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD002975] - DOI - PMC - PubMed
Ho 2007
    1. Ho JJ, Henderson‐Smart DJ, Davis PG. Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD002975] - DOI - PMC - PubMed

Publication types

MeSH terms