Early nasal continuous positive airway pressure and low threshold for intubation in very preterm infants

Acta Paediatr. 2008 Aug;97(8):1049-54. doi: 10.1111/j.1651-2227.2008.00867.x. Epub 2008 May 14.


Aim: To determine if selective intubation, use of early nasal continuous positive airway pressure (NCPAP) at birth with a low threshold for early surfactant treatment, reduces the need for intubation in very preterm infants in the first days after birth.

Methods: Two cohorts of very preterm infants < or = 32 weeks, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (1996-1997) and after (2003-2004) introducing selective intubation and use of early NCPAP. A FiO(2)> or = 0.40 was used as criterion for intubation. Primary outcome measure was intubation < 72 h of age. Bronchopulmonary dysplasia (BPD) was a secondary outcome.

Results: The rate of intubation in the delivery room (69% vs. 46%, p < 0.001) and within 72 h of age (73% vs. 57%, p < 0.001) was lower following the change in policy. Early NCPAP was, in 2003-2004, increasingly used as primary treatment (10% vs. 33%, p < 0.001) with higher maximum NCPAP levels (4.0 (0.9) vs. 5.8 (1.5), p < 0.001). There was no change in BPD (14.3% vs. 15.2%, p = 0.82).

Conclusion: Avoiding intubation by using early NCPAP while maintaining a low-threshold for surfactant treatment decreased the need for intubation.

MeSH terms

  • Algorithms
  • Bronchopulmonary Dysplasia / drug therapy
  • Bronchopulmonary Dysplasia / therapy*
  • Continuous Positive Airway Pressure / methods*
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intubation, Intratracheal*
  • Male
  • Pulmonary Surfactants / therapeutic use*


  • Pulmonary Surfactants