Nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome.

Background.- Early treatment with nasal continuous positive airway pressure (CPAP) in newborns with respiratory distress syndrome is useful, by recruiting alveoli and restoring the functional residual capacity. Population and methods.- Nasal CPAP was supplied by the Infant Flow Driver (Electro Medical Equipment). From 15 June 1994 to 15 December 1994, 42 neonates received nasal CPAP. Their mean birthweight and gestational age were 1511 +/- 411 g and 30.9 +/- 2.5 weeks, respectively. Fifteen infants had been ventilated for hyaline membrane disease and nasal CPAP was applied immediately after extubation. In the other 27 infants, nasal CPAP was given soon after birth (respiratory distress syndrome: 20 neonates; apneic spells: seven neonates). Results.- Three infants needed subsequent mechanical ventilation because of the severity of the disease (one had spontaneous pneumothorax); four infants received exogenous surfactant (Curosurf(R), one single dose) within a brief period of mechanical ventilation (30-45 min). There were no failure of extubation, and no intracranial lesions. Excess of pharyngeal secretion and abdominal distension were common. Conclusion.- Early treatment with nasal CPAP reduces the need for mechanical ventilation. Furthermore, surfactant therapy required by a moderate to severe disease is possible with a rather short period of artificial ventilation.