Impact of introducing binasal continuous positive airway pressure for acute respiratory distress in newborns during retrieval: Experience from Western Australia

Abstract

We aimed to review the impact of introducing binasal continuous positive airway pressure (CPAP) for acute respiratory distress in newborns ≥32 weeks gestation during retrieval in Western Australia. Retrospective review of newborns ≥32 weeks gestation with acute respiratory distress, transported by the Western Australian Neonatal Transport Service between February 2002 and December 2004. Respiratory management of 369 newborns was examined. CPAP use increased significantly during the study period from 33% in 2002 to 59% in 2004. Overall, endotracheal tube (ETT) ventilation was required in 108 (29%), nasal CPAP in 166 (45%) and cot oxygen in 95 (26%) patients. Twenty-two (13%) newborns in the CPAP group subsequently required ETT ventilation within 24 h: these babies had higher initial oxygen requirements than those successfully transported on CPAP alone. There was no significant morbidity or mortality in patients retrieved on CPAP. CPAP was increasingly utilised as an alternative to ETT ventilation for the management of most cases of less severe acute respiratory distress in near-term neonates on retrieval. This review demonstrated that newborns requiring more than 45-50% oxygen at the time of retrieval were more likely to require intubation at a later time, and hence may benefit from intubation at the time of retrieval. A prospective randomised trial would assist in ascertaining the true benefit of CPAP during retrieval in the newborn period.