Preterm Infants Using CPAP Masks
The use of CPAP masks and various forms of CPAP therapy delivery is becoming the accepted practice in pediatric medicine. This is particularly true with preterm infants with some form of a respiratory disorder, which is a fairly common problem. For these newborns, CPAP masks are gaining popularity as a non-invasive respiratory support mechanism.
Recently, the American Academy of Pediatrics (AAP) issued a new policy regarding CPAP therapy. It states that the use of CPAP masks and CPAP therapy were an effective alternative to routine intubation coupled with prophylactic or early surfactants soon after birth. The policy statement appeared in the January issue of Pediatrics. It normalizes the use of Pediatric CPAP masks and CPAP therapy as an accepted alternative treatment throughout pediatric medicine.
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Surfactant, naturally produced in the lungs of newborns, is a mix of lipids and proteins. It reduces the surface tension of fluid in the lungs. This substance helps make the small air sacs in the lungs (alveoli) more stable. It also keeps them from collapsing on exhalation.
In many cases, significantly premature infants do not produce enough surfactant. This requires the administration of surfactant replacement therapy immediately after birth in order to help them breathe. AAP’s Committee on Fetus and Newborn issued this new policy position. This looks to have a far-reaching impact on newborns that suffer from symptoms of this condition. Respiratory distress syndrome (RDS) is the name for this condition.
There are many trials that compared surfactant therapy utilizing intubation and mechanical ventilation alongside the use of CPAP masks and specific CPAP therapy delivery systems. The use of CPAP therapy showed lower rates of bronchopulmonary dysplasia and death. There were also significant amounts of data that showed mechanical ventilation can cause lung injury. It’s even more prevalent when used in the presence of surfactant deficiency.
Earlier trials like the one profiled in the May 2010 New England Journal of Medicine issue support the conclusions of the current position of the AAP.
The means by which the CPAP mask is utilized for CPAP therapy has been studied where the outcomes of the use of Bubble CPAP (B-CPAP) in relation to ventilator-derived CPAP has been measured in preterm infants with respiratory distress.
In B-CPAP, the positive pressure is generated by immersing the distal expiratory tubing in a water column to the desired depth rather than using a variable resistor. In fact, there have been a number of trials performed that support the results of the AAP conclusion and the use of B-CPAP in conjunction with CPAP masks.
The healthcare continuum is constantly finding new uses for CPAP masks and CPAP therapy. They want to improve health outcomes in a wide variety of breathing disorders. We know premature births and resultant complications are an ongoing challenge. The use of Pediatric CPAP masks with headgear in surfactant therapy for preterm infants can be a game-changer for many babies.
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