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COMMENTARY:
Alan M. de Klerk and Rosemary K. de Klerk
Use of Continuous Positive Airway Pressure in Preterm Infants: Comments and Experience From New Zealand
Pediatrics 2001; 108: 761-763 [Full text]
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[Read P3R] NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE AND REDUCED INCIDENCE OF CHRONIC LUNG DISEASE IN ELBW INFA
Giuseppe Latini, "De Felice Claudio, Giuseppe Presta"   (9 September 2001)

NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE AND REDUCED INCIDENCE OF CHRONIC LUNG DISEASE IN ELBW INFA 9 September 2001
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Giuseppe Latini,
Director Division of Pediatrics
Azienda Ospedaliera A. Di Summa, Brindisi,Italy,
"De Felice Claudio, Giuseppe Presta"

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Re: NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE AND REDUCED INCIDENCE OF CHRONIC LUNG DISEASE IN ELBW INFA

gilatini{at}tin.it Giuseppe Latini, et al.

Giuseppe Latini*, Claudio De Felice**, Giuseppe Presta* From the * Neonatal Intensive Care Unit, Division of Pediatrics, Ospedale Perrino, Azienda Ospedaliera A. Di Summa, Brindisi, Italy; ** Neonatal Intensive Care Unit, Department of Pediatrics, Obstetrics and Reproduction, University of Siena, Italy

Corresponding Author: G. Latini MD. Division of Pediatrics, Ospedale A. Perrino, Azienda Ospedaliera A. Di Summa Piazza Di Summa 72100 Brindisi (Italy). Tel :+39-831-537471;Fax:+39-831-537861;e-mail:gilatini@tin.it

Sir,

We read with great interest the paper by de Klerk et al.1 on the Columbia approach and respiratory outcome in very low birth weight infants. Since 1986 the Brindisi Neonatal Intensive Care Unit (NICU) has been using a minimal handling approach (nasal CPAP and/or nasal IPPV) for respiratory assistance in very low birth weight infants. From July 1, 1990 to July 1, 2001 a total of 57 extremely low birth weight (ELBW) infants admitted to the NICU (M:19, F:38; mean birth weight: 846!123 g; mean gestational age: 26.9±2.5 weeks) survived for at least 36 weeks’ postconceptional age. Oxygen-dependence at 28 days of postnatal age (BPD- 28d) was present in 22 infants (38.6%) while only 1 infant (1.7% of the whole ELBW population) still needed ventilatory support and supplemental oxygen at 36 weeks’ postconceptional age (BPD-36wk). The observed prevalence of BPD-36wk in ELBW infants is significantly lower than it should be expected (30%) from the literature2-3 (p=0.000041, Fisher's exact test, two-tailed probability). This observation seems to confirm that a less invasive approach to mechanical ventilation not only can, but has to be attempted although sufficiently large, randomized controlled trials are needed to verify our clinical experience. A possible explanation for the reduced incidence of BPD using a minimal approach may reside in the reduced exposure to phthalates released from endotracheal tubes.4

REFERENCES

1. de Klerk A, de Klerk RK. Use of Continuous Positive Airway Pressure in Preterm Infants: Comments and Experience From New Zealand Pediatrics 2001;108:761-763 2. Jobe AH, Bancalari E Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9 3. Stevenson DK, Wright LL, Lemons JA, Oh W, Korones SB, Papile LA, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol 1998;179:1632-9 4. Latini G, Avery GB. Materials degradation in endotracheal tubes: A potential contributor to Bronchopulmonary Dysplasia. Acta Ped. 1999;88:1174-1175.