{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:51:44Z","timestamp":1747183904158,"version":"3.40.5"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,7,1]]},"abstract":"<jats:p>BACKGROUND: The use of early nasal continuous positive airway pressure (ENCPAP) as the mode of initial respiratory support for very low birth weight (VLBW) infants has been increasing. The impact of CPAP and oxygen on gut mucosa and perfusion in premature infants is not known. The relation between ENCPAP and necrotizing enterocolitis (NEC) has not been adequately addressed.<\/jats:p><jats:p>OBJECTIVE: To evaluate if the use of an individualized respiratory management strategy encouraging the use of ENCPAP is associated with an increased risk of NEC, and to determine risk factors for NEC in premature infants supported by CPAP.<\/jats:p><jats:p>METHODS: A retrospective analysis was conducted on VLBW infants (birth weight &amp;lt; 1500 g) managed at 2 institutions that use an ENCPAP respiratory management strategy for premature infants. Data on the use of oxygen and mode of ventilatory support were collected during the first 3 days of life. Diagnosis of NEC was used as the dependent variable in a logistic regression model. Birth weight, gender, prenatal steroid use, mode of respiratory support (CPAP versus ventilator) and fraction of inspired oxygen, umbilical artery catheter placement, partial pressure of oxygen, patent ductus arteriosus, early sepsis, hospital, and delivery room management (ENCPAP versus initial intubation) were controlled for in the model.<\/jats:p><jats:p>RESULTS: Data on 343 premature infants were collected for this study. Mean birth weight was 999 \u00b1 289 g and gestational age was 28 \u00b1 2.6 weeks. The majority of patients were managed with ENCPAP, with only 13% of patients intubated in the delivery room. The overall incidence of NEC was 7% (n = 24). The exposure to ENCPAP did not increase the risk for NEC compared with the use of a ventilator.<\/jats:p><jats:p>CONCLUSIONS. The risk of NEC in VLBW premature infants was not increased by the use of ENCPAP. Initial respiratory support with ENCPAP seems to be a safe alternative to routine intubation and mechanical ventilation in premature infants.<\/jats:p>","DOI":"10.1542\/peds.2008-2588","type":"journal-article","created":{"date-parts":[[2009,6,29]],"date-time":"2009-06-29T15:18:44Z","timestamp":1246288724000},"page":"205-210","source":"Crossref","is-referenced-by-count":23,"title":["Early Nasal Continuous Positive Airway Pressure and Necrotizing Enterocolitis in Preterm Infants"],"prefix":"10.1542","volume":"124","author":[{"given":"Hany","family":"Aly","sequence":"first","affiliation":[{"name":"Departments of Neonatology"},{"name":"Newborn Services, George Washington University Medical Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"An N.","family":"Massaro","sequence":"additional","affiliation":[{"name":"Departments of Neonatology"},{"name":"Newborn Services, George Washington University Medical Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarek A.","family":"Hammad","sequence":"additional","affiliation":[{"name":"Newborn Services, George Washington University Medical Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry","family":"Narang","sequence":"additional","affiliation":[{"name":"Pediatrics, Children's National Medical Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonah","family":"Essers","sequence":"additional","affiliation":[{"name":"Pediatrics, Children's National Medical Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2009,7,1]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Avery ME, Tooley WH, Keller JB, et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics.\u20081987;79(1):26\u201330","key":"2021120902464755300_R1","DOI":"10.1542\/peds.79.1.26"},{"doi-asserted-by":"crossref","unstructured":"Jonsson B, Katz-Salamon M, Faxelius G, Broberger U, Lagercrantz H. Neonatal care of very-low-birthweight infants in special-care units and neonatal intensive care units in Stockholm: early nasal continuous positive airway pressure versus mechanical ventilation\u2014gains and losses. Acta Paediatr Suppl.\u20081997;419:4\u201310","key":"2021120902464755300_R2","DOI":"10.1111\/j.1651-2227.1997.tb18303.x"},{"doi-asserted-by":"crossref","unstructured":"Lindner W, Vossbeck S, Hummler H, Pohandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?Pediatrics.\u20081999;103(5 pt 1):961\u2013967","key":"2021120902464755300_R3","DOI":"10.1542\/peds.103.5.961"},{"doi-asserted-by":"crossref","unstructured":"Van Marter LJ, Allread EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics.\u20082000;105(6):1194\u20131201","key":"2021120902464755300_R4","DOI":"10.1542\/peds.105.6.1194"},{"doi-asserted-by":"crossref","unstructured":"Aly H, Milner JD, Patel K, El-Mohandes AA. Does the experience with the use of nasal continuous positive airway pressure improve over time in extremely low birth weight infants?Pediatrics.\u20082004;114(3):697\u2013702","key":"2021120902464755300_R5","DOI":"10.1542\/peds.2003-0572-L"},{"doi-asserted-by":"crossref","unstructured":"Aly H, Massaro AN, El-Mohandes AA. Can delivery room management impact the length of hospital stay in premature infants?J Perinatol.\u20082006;26(10):593\u2013596","key":"2021120902464755300_R6","DOI":"10.1038\/sj.jp.7211575"},{"doi-asserted-by":"crossref","unstructured":"Meyer M, Mildenhall L, Wong M. Outcomes for infants weighing less than 1000 grams cared for with a nasal continuous positive airway pressure-based strategy. J Paediatr Child Health.\u20082004;40(1\u20132):38\u201341","key":"2021120902464755300_R7","DOI":"10.1111\/j.1440-1754.2004.00287.x"},{"doi-asserted-by":"crossref","unstructured":"Aly H, Massaro AN, Patel K, El-Mohandes AA. Is it safer to intubate premature infants in the delivery room?Pediatrics.\u20082005;115(6):1660\u20131665","key":"2021120902464755300_R8","DOI":"10.1542\/peds.2004-2493"},{"doi-asserted-by":"crossref","unstructured":"Srinivasan PS, Brandler MD, D'Souza A. Necrotizing enterocolitis. Clin Perinatol.\u20082008;35(1):251\u2013272","key":"2021120902464755300_R9","DOI":"10.1016\/j.clp.2007.11.009"},{"doi-asserted-by":"crossref","unstructured":"Hunter CJ, Upperman JS, Ford HR, Camerini V. Understanding the susceptibility of the premature infant to necrotizing enterocolitis. Pediatr Res.\u20082008;63(2):117\u2013123","key":"2021120902464755300_R10","DOI":"10.1203\/PDR.0b013e31815ed64c"},{"doi-asserted-by":"crossref","unstructured":"Havranek T, Thompson Z, Carter JD. Factors that influence mesenteric blood flow velocity in newborn preterm infants. J Perinatol.\u20082006;26(8):493\u2013497","key":"2021120902464755300_R11","DOI":"10.1038\/sj.jp.7211551"},{"doi-asserted-by":"crossref","unstructured":"Mandava S, Kolobow T, Vitale G, et al. Lethal systemic capillary leak syndrome associated with severe ventilator-induced injury: an experimental study. Crit Care Med.\u20082003;31(3):885\u2013892","key":"2021120902464755300_R12","DOI":"10.1097\/01.CCM.0000050294.04869.B8"},{"doi-asserted-by":"crossref","unstructured":"Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg.\u20081978;187(1):1\u20137","key":"2021120902464755300_R13","DOI":"10.1097\/00000658-197801000-00001"},{"doi-asserted-by":"crossref","unstructured":"Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med.\u20082008;358(7):700\u2013708","key":"2021120902464755300_R14","DOI":"10.1056\/NEJMoa072788"},{"doi-asserted-by":"crossref","unstructured":"Jaile JC, Levin T, Wung JT, et al. Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. AJR Am J Roentgenol.\u20081992;158(1):125\u2013127","key":"2021120902464755300_R15","DOI":"10.2214\/ajr.158.1.1727337"},{"doi-asserted-by":"crossref","unstructured":"Gounaris A, Costalos C, Varchalama L, Kokori P, Kolovou E, Alexiou N. Gastric emptying in very-low-birth-weight infants treated with nasal continuous positive airway pressure. J Pediatr.\u20082004;145(4):508\u2013510","key":"2021120902464755300_R16","DOI":"10.1016\/j.jpeds.2004.06.030"},{"doi-asserted-by":"crossref","unstructured":"Havranek T, Madramootoo C, Carver JD. Nasal continuous positive airway pressure affects pre- and postprandial intestinal blood flow velocity in preterm infants. J Perinatol.\u20082007;27(11):704\u2013708","key":"2021120902464755300_R17","DOI":"10.1038\/sj.jp.7211808"},{"doi-asserted-by":"crossref","unstructured":"Neu J, Zhang I. Feeding intolerance in very low-birth-weight infants: what is it and what can we do about it?Acta Paediatr Suppl.\u20082005;94(449):93\u201399","key":"2021120902464755300_R18","DOI":"10.1111\/j.1651-2227.2005.tb02162.x"},{"doi-asserted-by":"crossref","unstructured":"Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin, and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr.\u20082005;40(2):184\u2013188","key":"2021120902464755300_R19","DOI":"10.1097\/00005176-200502000-00019"},{"doi-asserted-by":"crossref","unstructured":"Abdel-Hady H, Matter M, Hammad A, El-Refaay A, Aly H. Hemodynamic changes during weaning of nasal continuous positive airway pressure. Pediatrics.\u20082008;122(5). Available at:www.pediatrics.org\/cgi\/content\/full\/122\/5\/e1086","key":"2021120902464755300_R20","DOI":"10.1542\/peds.2008-1193"},{"doi-asserted-by":"crossref","unstructured":"Tyson JE, DeSa DJ, Moore S. Thromboatheromatous complications of umbilical arterial catheterization in the newborn period. Clinicopathological study. Arch Dis Child.\u20081976;51(10):744\u2013754","key":"2021120902464755300_R21","DOI":"10.1136\/adc.51.10.744"},{"doi-asserted-by":"crossref","unstructured":"Mokrohisky ST, Levine RL, Blumhagen JD, Wesenberg RL, Simmons MA. Low positioning of umbilical-artery catheters increases associated complications in newborn infants. N Engl J Med.\u20081978;299(11):561\u2013564","key":"2021120902464755300_R22","DOI":"10.1056\/NEJM197809142991101"},{"doi-asserted-by":"crossref","unstructured":"Wesstro\u0308m G, Finnstro\u0308m O, Stenport G. Umbilical arterery catheterization in newborns. I. Thrombosis in relation to catheter type and position. Acta Paediatr Scand.\u20081979;68(4):575\u2013581","key":"2021120902464755300_R23","DOI":"10.1111\/j.1651-2227.1979.tb05058.x"},{"doi-asserted-by":"crossref","unstructured":"Rand T, Weniger M, Kohlhauser C, et al. Effects of umbilical arterial catherterization on mesenteric hemodynamics. Pediatr Radiol.\u20081996;26(7):435\u2013438","key":"2021120902464755300_R24","DOI":"10.1007\/BF01377197"},{"doi-asserted-by":"crossref","unstructured":"Blanco CL, Baillargeon JG, Morrison RL, Gong AK. Hyperglycemia in extremely low birth weight infants in a predominantly Hispanic population and related morbidities. J Perinatol.\u20082006;26(12):737\u2013741","key":"2021120902464755300_R25","DOI":"10.1038\/sj.jp.7211594"},{"doi-asserted-by":"crossref","unstructured":"Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol.\u20082006;26(12):730\u2013736","key":"2021120902464755300_R26","DOI":"10.1038\/sj.jp.7211593"},{"doi-asserted-by":"crossref","unstructured":"Oh W, Poindexter BB, Perritt R, et al. Association between fluid intake and weight loss during the first 10 days of life and risk for bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr.\u20082005;147(6):786\u2013790","key":"2021120902464755300_R27","DOI":"10.1016\/j.jpeds.2005.06.039"},{"doi-asserted-by":"crossref","unstructured":"Reber KM, Nankervis CA, Nowicki PT. Newborn intestinal circulation physiology and pathophysiology. Clin Perinatol.\u20082002;29(1):23\u201339","key":"2021120902464755300_R28","DOI":"10.1016\/S0095-5108(03)00063-0"},{"doi-asserted-by":"crossref","unstructured":"Robel-Tillig E, Knupfer M, Pulzer F, Vogtmann C. Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants. Pediatr Radiol.\u20082004;34(12):958\u2013962","key":"2021120902464755300_R29","DOI":"10.1007\/s00247-004-1285-6"},{"doi-asserted-by":"crossref","unstructured":"Maruyama K, Koizumi T, Tomomasa T, Morikawa A. Intestinal blood-flow velocity in uncomplicated preterm infants during the early neonatal period. Pediatr Radiol.\u20081999;29(6):472\u2013477","key":"2021120902464755300_R30","DOI":"10.1007\/s002470050621"},{"doi-asserted-by":"crossref","unstructured":"Fang S, Kempley ST, Gamsu HR. Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity. Arch Dis Child Fetal Neonat Ed.\u20082001;85(1):F42\u2013F45","key":"2021120902464755300_R31","DOI":"10.1136\/fn.85.1.F42"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/1\/205\/1031886\/zpe00709000205.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/1\/205\/1031886\/zpe00709000205.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T20:50:47Z","timestamp":1685047847000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/124\/1\/205\/71648\/Early-Nasal-Continuous-Positive-Airway-Pressure"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,7,1]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2009,7,1]]},"published-print":{"date-parts":[[2009,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-2588","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2009,7,1]]}}}