Choosing the optimal ventilatory support at birth for very preterm infants to prevent evolution to bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia remains a severe complication of prematurity and invasive ventilation is a major risk factor for developing bronchopulmonary dysplasia. Our aim is to compare different ventilation methods in the delivery room and the subsequent risk of bronchopulmonary dysplasia. Medline database was searched from 2005 to 2019. Articles in English including infants born at ≤ 32 weeks who received non-invasive respiratory support in the delivery room were considered. Sixteen articles were included. A systematic review and meta-analysis found a reduction of bronchopulmonary dysplasia in very preterm infants treated with nasal continuous positive airway pressure. Pooled analysis found a significant reduction in the combined outcome of bronchopulmonary dysplasia or death or both at 36 weeks in infants randomized to the nasal continuous positive airway pressure group, number needed to treat of 25. Another meta-analysis found a significant lower risk on death or bronchopulmonary dysplasia using strategies avoiding mechanical ventilation (P=0.008), number needed to treat of 32. Only one study, a cohort study with a historical control group, found a statistically significant lower occurrence of bronchopulmonary dysplasia in very preterm infants who received sustained lung inflations.

Conclusion: prevention of bronchopulmonary dysplasia in very and extremely preterm infants should start in the delivery room. The use of early nasal continuous positive airway pressure could be recommended. Sustained inflations and nasal intermittent positive pressure ventilation in the delivery room do not reduce the incidence of bronchopulmonary dysplasia and are not recommended.