Nasal CPAP or intubation at birth for very preterm infants

Morley, Colin J., Davis, Peter G., Doyle, Lex W., Brion, Luc P., Hascoet, Jean-Michel, Carlin, John B., for the COIN Trial Investigators and Pritchard, M. (2008) Nasal CPAP or intubation at birth for very preterm infants. New England Journal of Medicine, 358 7: 700-708. doi:10.1056/NEJMoa072788

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Author Morley, Colin J.
Davis, Peter G.
Doyle, Lex W.
Brion, Luc P.
Hascoet, Jean-Michel
Carlin, John B.
for the COIN Trial Investigators
Pritchard, M.
Title Nasal CPAP or intubation at birth for very preterm infants
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
Publication date 2008-02-14
Year available 2008
Sub-type Article (original research)
DOI 10.1056/NEJMoa072788
Open Access Status File (Publisher version)
Volume 358
Issue 7
Start page 700
End page 708
Total pages 9
Place of publication Waltham, MA, United States
Publisher Massachusetts Medical Society
Language eng
Subject 2700 Medicine
Abstract Background: Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would reduce the rate of death or bronchopulmonary dysplasia in very preterm infants. Methods: We randomly assigned 610 infants who were born at 25-to-28-weeks' gestation to CPAP or intubation and ventilation at 5 minutes after birth. We assessed outcomes at 28 days of age, at 36 weeks' gestational age, and before discharge. Results: At 36 weeks' gestational age, 33.9% of 307 infants who were assigned to receive CPAP had died or had bronchopulmonary dysplasia, as compared with 38.9% of 303 infants who were assigned to receive intubation (odds ratio favoring CPAP, 0.80; 95% confidence interval [CI], 0.58 to 1.12; P=0.19). At 28 days, there was a lower risk of death or need for oxygen therapy in the CPAP group than in the intubation group (odds ratio, 0.63; 95% CI, 0.46 to 0.88; P=0.006). There was little difference in overall mortality. In the CPAP group, 46% of infants were intubated during the first 5 days, and the use of surfactant was halved. The incidence of pneumothorax was 9% in the CPAP group, as compared with 3% in the intubation group (P<0.001). There were no other serious adverse events. The CPAP group had fewer days of ventilation. Conclusions: In infants born at 25-to-28-weeks' gestation, early nasal CPAP did not significantly reduce the rate of death or bronchopulmonary dysplasia, as compared with intubation. Even though the CPAP group had more incidences of pneumothorax, fewer infants received oxygen at 28 days, and they had fewer days of ventilation. (Australian New Zealand Clinical Trials Registry number, 12606000258550.) Copyright
Keyword Medicine, General & Internal
General & Internal Medicine
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
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