Early Nasal Continuous Positive Airway Pressure and Minimal Handling in the Treatment of Very-Low-Birth-Weight Infants

Continuous positive airway pressure (CPAP) was introduced in 1971 and at that time welcomed as 'the missing link' between oxygen and ventilator treatment of premature infants. Originally CPAP was administered by tracheal tube (or head box) which because of the inherent risk of complications necessitated a cautious approach. New, more simple and less risky methods of application, such as nasal CPAP (N-CPAP), permitted earlier treatment which in randomized trials showed a reduction in inspired oxygen concentration, reduced need for mechanical ventilation and a reduction in the rate of death. Early N-CPAP/minimal handling today is an established first-line treatment in a number of centers in Denmark and Sweden, while N-CPAP outside Scandinavia apparently is used less often. However, recently the method has gained new interest as more publications have demonstrated that N-CPAP/minimal handling is both feasible and effective in most very-low-birth-weight infants. Early rescue treatment with fast-acting surfactant, given during a brief intubation, has increased the effectiveness of N-CPAP further. Descriptive studies on N-CPAP suggest that the risk of bronchopulmonary dysplasia may be lower than in conventional intensive treatment because of the relatively low need for mechanical ventilation. This question is at the present time being addressed in a randomized controlled trial in England.