Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 198 (doi:10.1542/peds.2004-2355)

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Delivery Room Continuous Positive Airway Pressure: Practice and Feasibility: In Reply

Neil N. Finer, MD
Department of Pediatrics,
University of California,
San Diego, CA 92103-8774

Waldemar A. Carlo, MD
Department of Pediatrics,
University of Alabama,
Birmingham, AL 35294

Shahnaz Duara, MD
Department of Pediatrics,
University of Miami,
Miami, FL 33136

Edward F. Donovan, MD
Department of Pediatrics,
College of Medicine,
University of Cincinnati,
Cincinnati, OH 45221

Avroy A. Fanaroff, MB, BCh
Department of Pediatrics,
Case Western Reserve University,
Cleveland, OH 44106

In Reply.—

We thank Hand and Noble for their comments and agree that there is a definite learning curve with the introduction of any new technology. We are about to begin the SUPPORT trial, which will compare the use of early continuous positive airway pressure (CPAP) and a permissive ventilator strategy started at delivery and early surfactant followed by conventional ventilation, similar to the COIN trial, in infants of 24 to 27 6/7 weeks' gestation. In addition, the infants will be randomized to 2 target ranges of oxygen saturation (85% to 89% and 91% to 95%), starting within 2 hours of birth.

We believe that it is important not to encourage the dissemination of any new form of therapy for preterm infants until it has been demonstrated to be efficacious and safe without compromising longer-term neurodevelopmental outcome, lest we repeat mistakes from our past.¹ Sandri et al² recently reported that there is no advantage of early/prophylactic CPAP compared with later rescue CPAP for infants of 28 to 31 weeks' gestation in terms of the need for later intubation surfactant and ventilation. The most optimal use of CPAP in the very low birth weight infant has yet to be determined.

The use of CPAP predated surfactant in neonatal medicine, and although both have been available for at least 10 years, there has not been a well-designed and powered prospective trial comparing these 2 therapies. We believe that additional prospective randomized trials such as the COIN Trial, the Vermont Oxford Network trial, and the SUPPORT trial will provide additional evidence for the potential benefit of CPAP compared with early surfactant in such infants. There are many forks in the road to evidence-based neonatal care, and, following the advice of Yogi Berra, we need to "take them" to their logical conclusion.

REFERENCES

1. American Academy of Pediatrics, Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics. 2002;109 :330 –338[Abstract/Free Full Text]
2. Sandri F, Ancora G, Lanzoni A, et al. Prophylactic nasal continuous positive airways pressure in newborns of 28–31 weeks gestation: multicentre randomised controlled clinical trial. Arch Dis Child Fetal Neonatal Ed. 2004;89 :F394 –F398[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Finer, N. N. Articles by Fanaroff, A. A. Search for Related Content PubMed Articles by Finer, N. N. Articles by Fanaroff, A. A. Related Collections Premature & Newborn Social Bookmarking                         What's this?