455 - The CORSAD Randomized Clinical Trial: A Single-Center Experience and Follow-up

Poster Number: 455
Publication Number: 455.228

Sonja Baldursdottir, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Snorri Donaldsson, Karolinska/University Hospital of Iceland, Garðabær, Hofuoborgarsvaoio, Iceland; Thomas Drevhammar, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Baldvin Jonsson, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden

Background: Modern neonatal stabilization and respiratory support aims to support the infants breathing with minimally invasive methods to avoid mechanical ventilation and reduce the risk of developing bronchopulmonary dysplasia (BPD). A new respiratory support system with low imposed work of breathing aimed for delivery room stabilization has been developed. The multicenter CORSAD randomized clinical trial found that initial respiratory support with the new system using nasal prongs compared with a standard T-piece system with a face mask reduced delivery room intubations in extremely preterm infants. The follow-up period of the multicenter CORSAD trial was 72 h after birth.

Objective: To describe respiratory outcomes and other neonatal morbidities until 36 weeks postmenstrual age (PMA) in infants born before 28 weeks gestational age (GA) that have received initial respiratory support with the new system vs T-piece.

Design/Methods: This is a follow-up study of all extremely preterm infants ( < 28 weeks GA) that were born in the Karolinska University Hospital in Sweden during 2016-2020 and included in the CORSAD trial that randomized infants to initial respiratory support in the delivery room with the new system vs T-piece. Information during first 72 h of life was gathered prospectively in the CORSAD trial and retrospectively for the follow-up period until 36 weeks PMA. BPD was defined as need for respiratory support at 36 weeks PMA.

Results: In total 94 infants with a median GA 25,3 weeks, 54.2% female, were included in the CORSAD trial in Stockholm. In the new system group 13/46 (28.3%) were intubated in the delivery room and 26/48 (54.2%) in the T-piece group (P=.01). Any mechanical ventilation during first 72 h was 52.2% in the new system vs 72.9% in the T-piece group (P=.04) and 76.1% in the new system vs 89.6% in the T-piece group at any time before discharge (P=.08). BPD or death occurred in 53.3% in the new system group compared with 51.1% in the T-piece group. No significant differences were seen in IVH, NEC, ROP or PDA treatment.Conclusion(s): Infants receiving initial respiratory support with the new system were less likely to receive mechanical ventilation during the first 72 h of life. The difference decreased over time possibly due to the occurrence of other morbidities resulting in need for mechanical ventilation. The combined outcome of BPD or death did not differ between the groups.
Background characteristics8E9717C6-389A-466E-B183-7BAC1E8C73D5.jpegGroups had similar background characteristics except for IUGR which was more common in the new system group.
Abbreviations: GA=gestational age, IUGR=intrauterine growth retardation, AB=antibiotics, PROM=premature rupture of membranes