488 - Transition of extremely preterm infants from birth to stable breathing. A secondary analysis of the CORSAD trial.

Poster Number: 488
Publication Number: 488.231

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

Background: In recent years the focus has shifted from an aggressive resuscitation approach to a more gentle, physiological approach when stabilizing preterm infants in the delivery room. There has also been an increasing interest in improving interfaces and devices in the delivery room (DR) setting. The recently completed CORSAD trial showed that using a new device for respiratory support for extremely preterm infants after birth decreased delivery room intubations compared with using the standard T-piece system. The new device differs from the T-piece in two important aspects, it is pressure stable with low imposed work of breathing and it can be used with a nasal interface instead of a face mask.

Objective: In this secondary analysis of the CORSAD trial, we focused on the subgroup of infants that were not intubated in the delivery room. The aim was to compare the use of non-invasive positive pressure ventilation (PPV) and vital parameters such as saturation and Apgar scores for for the two resuscitation systems during the 30 minutes intervention period.

Design/Methods: Secondary analysis of  CORSAD trial using data from the intervention period in the DR. Infants in the randomized system groups were divided into intubated and non-intubated groups. We compared demographics,  the use of PPV, APGAR scores and saturation at 5 and 10 minutes after birth of the infants that were breathing and were not intubated in the DR. Generalized linear model was applied to calculate the risk difference with 95% CI between the two group.

Results: The use of  PPV used repeatedly (defined as PPV with at least 1 minute of spontaneous breathing between PPV cycles) was less in the New-system group ( 23.6% vs 37.7%, Risk difference (95%CI) -14.1( -25.5 to-2.7) p 0.02).  PPV used after 5 minutes of age was also less common in the New-system group (36.6% vs 50.0%, RD -13.4(–25.7 to -1.1  ) p 0.03. There were no statistical differences in APGAR scores or saturation between the groups. Conclusion(s): In the group of infants that were not intubated during the intervention period in the CORSAD trial, fewer infants needed PPV repeatedly and after 5 minutes of age in the New-system group compared to the standard T-piece group. This shows, in combination with the original findings from the CORSAD trail, that using the New-system facilitates the transition from birth to stable breathing in a less invasive and aggressive way in extremely preterm infants.