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Minerva Pediatrica 2005 October;57(5):281-4

language: English

The increase of oxygen requirement as index to identify the infants at high risk of pneumothorax during nasal continuous positive airway pressure

Migliori B., Pontiggia F., Chirico G.


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Aim. The aim of this study was to evaluate the inspiration fraxion of oxygen (FiO2) trend as an indicator of timing to suspend nasal continuous positive airway pressure (N-CPAP) and shift the babies to mechanical ventilation, in order to reduce the incidence of pneumothorax, comparing a similar population admitted in our division during the previous year.
Methods. Seventy-five newborns (mean gestational age 33.5 weeks, mean birth weight 2 072 g) admitted during 2003 in our Neonatal Intensive Care Unit, treated with Infant Flow Systemâ„¢ Nasal-CPAP, were included. Patients with more than 40% increase of the starting FiO2 in the first 24 h of treatment, were intubated and shift on mechanical ventilation. Seventy-seven infants, admitted during the previous year, with similar characteristics (mean gestational age 33.7 weeks, mean birth weight 2 047 g) were considered as control.
Results. Fifty-six neonates improved, 19 worsened and required mechanical ventilation. One of these developed pneumothorax (1.3%). Of the 77 infants admitted during the previous year, 26 worsened and were mechanically ventilated, and 8 developed pneumothorax (10.3%). The difference of incidence of pneumothorax was significant (P =0.0337).
Conclusion. An increase of FiO2 more than 40% of the initial value during the first 24 h of N-CPAP may be considered a useful marker to identify infants at high risk of pneumothorax.

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