Published online May 1, 2006
PEDIATRICS
Vol. 117
No. 5
May 2006, pp.
1858-1859
(doi:10.1542/peds.2005-3210)
Is It Safer to Intubate Premature Infants in the Delivery Room?
Angela Kribs, MD
Department of Neonatology
Children's Hospital
University of Cologne
Cologne 50924, Germany
To the Editor.
I read with interest the article "Is It Safer to Intubate Premature Infants in the Delivery Room?" by Aly et al.1
In our hospital, early nasal continuous positive airway pressure (ENCPAP) has also been established since 1995 as a possible initial respiratory support for very low birth weight (VLBW) infants. Like Aly et al, we could observe an increasing use of ENCPAP over time, reflecting the experience of the staff. In our unit the increasing experience led to the development in 1997 of an internal hospital guideline for CPAP management in the delivery room. Following this guideline, VLBW infants are managed with ENCPAP if their Apgar score is 
6 after 5 minutes. We used this guideline in an unchanged way until 2001. In 2001, we treated 100 VLBW infants; of these 100, 72 were managed with ENCPAP in the delivery room, 28 had to be intubated, and 23 who were primarily managed with ENCPAP were intubated during the first 3 days of life because of infant respiratory distress syndrome. This kind of CPAP failure occurred mainly in the group of extremely low birth weight (ELBW) infants and VLBW infants with a gestational age of 
27 weeks. Our results in this period were very similar to those described by Aly et al.
On the basis of theoretical reflection and animal data,2 we decided in 2002 to combine our approach with early surfactant administration for infants with clinical signs of moderate or severe infant respiratory distress syndrome. During 2002 we developed the method to apply surfactant during ENCPAP via a thin endotracheal catheter and trained the staff to carry out the procedure. In 2003, the method was implemented as a standard procedure. With the combination of ENCPAP and surfactant, success of ENCPAP increased also for ELBW infants, as shown in Fig 1.
From 2002–2004 we treated 315 VLBW infants, 136 of whom were ELBW infants. Eighty percent of the VLBW infants were managed with ENCPAP in the delivery room, with a rate of need for secondary intubation of 20%. There were no significant differences in the results between ELBW infants and infants born between 1000 and 1500 g, but 90% of the ELBW infants received surfactant, whereas only 20% of the infants born between 1000 and 1500 g received surfactant. These rates have been stable over the last few years. Overall mortality in our collective of VLBW infants is 7.5%.
Because this clinical observation suggests that avoidance of mechanical ventilation is possible also in ELBW infants with good results, we are convinced that there is an urgent need for prospective studies in this field.
REFERENCE
- Aly H, Massaro AN, Patel K, El-Mohandes AA. Is it safer to intubate premature infants in the delivery room?
Pediatrics. 2005;115
:1660
–1665[Abstract/Free Full Text]
- Thomson MA. Continuous positive airway pressure and surfactant: combined data from animal experiments and clinical trials.
Biol Neonate. 2002;81(suppl 1)
:16
–19
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
Related articles in Pediatrics:
- Is It Safer to Intubate Premature Infants in the Delivery Room?: In Reply
- Hany Aly
Pediatrics 2006 117: 1859.
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