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. 2022 Jun;42(6):761-768.
doi: 10.1038/s41372-022-01334-4. Epub 2022 Feb 16.

Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age

Edward F Stocks  1   2 , Mambarambath Jaleel  1 , William Smithhart  1   3 , Patti J Burchfield  1 , Anita Thomas  1 , Kate Louise M Mangona  1 , Vishal Kapadia  1 , Myra Wyckoff  1 , Venkatakrishna Kakkilaya  1 , Shelby Brenan  1   4 , L Steven Brown  5 , Christopher Clark  5 , David B Nelson  1   5 , Luc P Brion  6
Affiliations

Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age

Edward F Stocks et al. J Perinatol. 2022 Jun.

Abstract

Objective: 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-O2 supplementation (DR-PPV/O2).

Study design: 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/O2.

Results: 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).

Conclusion: The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow diagram: pneumothorax on first day of life vs. DR-CPAP and DR-O2.
CPAP-associated pneumothorax, confirmed pneumothorax on 1st chest radiogram & 1st day of life after exposure to DR-CPAP without DR-PPV, excluding positive pressure initiated in the NICU and prior PPV; spontaneous pneumothorax, confirmed pneumothorax on 1st chest radiogram & 1st day of life without prior exposure to PPV or CPAP. Abbreviations: GA gestational age, DR delivery room, NICU neonatal intensive care unit, DR-PPV delivery room positive pressure ventilation, CPAP continuous positive airway pressure, PTX pneumothorax on 1st chest radiogram & 1st day of life.
Fig. 2
Fig. 2. Changes over time (Control P charts) in exposure to DR-CPAP (Panel A) and pneumothorax during the first day of life (Panels B-D) among 6097 neonates in NICU subgroup who did not receive O2 in the delivery room during the two Epochs.
Panel (A): DR-CPAP: The frequency of DR-CPAP decreased from 6.9% in Epoch-1 to 1.2% in Epoch-2. Panel (B). Any pneumothorax: The frequency of any pneumothorax decreased from 3.0% in Epoch-1 to 1.2% in Epoch-2. Panel (C). CPAP-associated pneumothorax: The frequency of CPAP-associated pneumothorax decreased from 1.38% in Epoch-1 to 0.06% in Epoch-2. Panel (D) Spontaneous pneumothorax: The frequency of spontaneous pneumothorax did not change significantly from Epoch-1 to Epoch-2. CPAP-associated pneumothorax, confirmed CPAP-associated pneumothorax (following DR-CPAP, pneumothorax visible on 1st radiogram and 1st day postnatal, excluding positive pressure initiated in the NICU and prior PPV); spontaneous pneumothorax, confirmed pneumothorax on 1st radiogram and 1st day postnatal without any prior PPV or CPAP. Abbreviations: DR-CPAP delivery room continuous positive airway pressure, NICU neonatal intensive care unit, O2 oxygen, Epoch-1 baseline, Epoch-2 after de-implementation of DR-CPAP in neonates not needing oxygen or positive pressure ventilation in the delivery room, UCL upper control limit, CL central line, CPAP continuous positive airway pressure, DR delivery room, PPV positive pressure ventilation.
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