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1796 Incidence of and Risk Factors for Air Leaks in Preterm Infants Exposed to Restrictive use of Endotracheal Intubation
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  1. H Hummler1,
  2. E Parys1,
  3. J Essers1,
  4. R Hopfner1,
  5. O Beringer1,
  6. B Mayer2,
  7. H Fuchs1,
  8. M Schmid1
  1. 1Dept. of Pediatrics, Children’s Hospital, University of Ulm
  2. 2Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany

Abstract

Introduction The occurrence of air leaks such as pneumothorax (PTX), pneumopericardium (PPC) and pulmonary interstitial emphysema (PIE) may be a life-threatening condition in preterm infants.

Aim of the Study To study the incidence of and risk factors for air leaks in preterm infants treated with a policy of sustained inflations followed by non-invasive ventilation in the delivery room.

Methods Perinatal variables, variables of delivery room support and respiratory support in the NICU were analyzed retrospectively for infants with/without air leaks in preterm infants < 30 wks GA born 2005–2009 (n=297).

Results Median (range) gestational age was 26+0 (22+4–29+1) wks, birth weight was 790 (265–1660) g and 270/297 (91.0%) survived. 63 (21.2%) developed any air leak, 32 (10.8%) developed PTX, 44 (14.8%) PIE, and 1 (0.3%) PPC. Infants with air leaks had a higher risk for death (18 (28.6%) vs. 9 (3.8%), p<0.01) and for IVH Grade 3–4 (16 (25.4%) vs. 29 (12.4%), p<0.05). Air Leaks were associated with less use of prenatal steroids (44 (69.8%) vs. 199 (85.4%), p<0.01) and a more common use of cardiac compressions (9 (14.3%) vs. 11 (4.7%), p<0.01), use of a pressure of 30 cmH2O for sustained inflations (32 (55.2)% vs. 80 (36.7%), p<0.05) and intubation during initial resuscitation (34 (54.0%) vs. 60 (25.6%), p<0.01).

Conclusion Air leaks were associated with an increased risk for mortality and severe IVH. Our approach resulted in a high rate of survival but was associated with a substantial rate of air leaks. Randomized trials are necessary further improve delivery room care.

https://doi.org/10.1136/archdischild-2012-302724.1796

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