Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm

Acta Paediatr. 2007 Jan;96(1):10-6; discussion 8-9. doi: 10.1111/j.1651-2227.2007.00063.x.


Aim: To evaluate if different resuscitation and ventilatory styles exist between two neonatal units, and if the less aggressive approach has a beneficiary effect on BPD outcome.

Method: Inborn infants delivered at a gestational age <28 weeks were retrospectively studied (Boston = 70 and Stockholm = 102). Data were collected from birth to discharge or to 40 weeks.

Results: The study groups were similar with regard to gestational age, birth weight, gender and CRIB score, whereas SNAPPE-II score was greater in Stockholm and prenatal steroids were given less frequently in Boston. In Stockholm, continuous positive airway pressure (CPAP) was applied in the delivery room for 56% of the infants and the prevalence of infants not requiring intubation or mechanical ventilation (MV) during the first week of life was 22%. In Boston all infants were initially intubated. Subsequently, CPAP was used less often, and higher mean airway pressures (MAWPs) were applied during the first 4 weeks of life. Mortality and moderate/severe BPD at 36 weeks were similar; however, at 40 weeks oxygen supplementation was more frequent in Boston. Site was a predictor for moderate/severe BPD or death at 40 weeks.

Conclusion: Practice style differences exist and the less aggressive approach with more CPAP administration was successful. It did not decrease the risk for BPD at 36 weeks; however, at 40 weeks, fewer infants were on oxygen support, and a strong association was found between site, MAWP or MV with pulmonary morbidity indicating that CPAP could have a beneficiary role in outcome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Boston
  • Bronchopulmonary Dysplasia / epidemiology*
  • Continuous Positive Airway Pressure*
  • Female
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Extremely Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal*
  • Intubation, Intratracheal*
  • Male
  • Morbidity
  • Neonatology / methods
  • Oxygen Inhalation Therapy*
  • Respiration, Artificial / methods
  • Resuscitation / methods*
  • Retrospective Studies
  • Sweden
  • Treatment Outcome