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

摘要: BACKGROUND The application of a continuous distending pressure (CDP) has been shown to have some benefits in the treatment pre-term infants with respiratory distress syndrome (RDS). CDP potential reduce lung damage, particularly if applied early before atelectasis occurred. Early may better conserve an infant's own surfactant stores and consequently be more effective than later course RDS. OBJECTIVES In RDS determine compared delayed initiation results lower mortality reduced need for intermittent positive ventilation. SEARCH STRATEGY standard search strategy Cochrane Neonatal Review Group was used. This included searches Oxford Database Perinatal Trials, Controlled Trials Register (Issue 1, 2002), MEDLINE (1966-2001), previous reviews including cross references, abstracts, conference symposia proceedings, expert informants, journal hand searching mainly English language. SELECTION CRITERIA among spontaneously breathing at trial entry, which used random or quasi-random allocation either CDP. DATA COLLECTION AND ANALYSIS Standard methods Collaboration its were used, independent assessment quality extraction data by two authors. MAIN RESULTS six studies on total 165 infants, associated significant reduction subsequent use ventilation, typical RR 0.55, RD -0.16, NNT 6, but there no evidence effect overall mortality. There rates pneumothorax (five studies) bronchopulmonary dysplasia (one study). resulted duration oxygen therapy single study reporting this outcome. REVIEWER'S CONCLUSIONS clinical benefit that it reduces IPPV thus useful preventing adverse effects treatment. However, many trials done 1970s 1980s re-evaluation era antenatal steroid administration is indicated.