Two clinical reports and a policy statement from the AAP Committee on Fetus and Newborn address the care of preterm infants. They are published in the January issue of Pediatrics.
Respiratory Support in Preterm Infants at Birth describes how recent trials indicate that early use of nasal continuous positive airway pressure (CPAP) may be an effective alternative to prophylactic or early surfactant administration. The policy statement suggests clinicians may consider CPAP started at or soon after birth with subsequent selective surfactant administration as an alternative to routine intubation with prophylactic or early surfactant administration in preterm infants (
Pediatrics 2013;133:171-174).Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress, an update to a 2008 clinical report, summarizes the evidence for indications, administration, formulations and outcomes for surfactant-replacement therapy. The report states that preterm infants born at less than 30 weeks’ gestation who need mechanical ventilation because of severe respiratory distress syndrome should be given surfactant after initial stabilization. The report also underscores the message about use of CPAP in the policy listed above. (
Pediatrics 2013;133:156-163).Use of Inhaled Nitric Oxide in Preterm Infants provides guidance along with a literature review and cost-benefit analyses of routine use of inhaled nitric oxide. Among the statements in the clinical report: 1) Studies show neither rescue nor routine use of inhaled nitric oxide improves survival in preterm infants with respiratory failure. 2) Most evidence does not support its use to prevent or ameliorate bronchopulmonary dysplasia, severe intraventricular hemorrhage or other neonatal morbidities. 3) Incidence of cerebral palsy, neurodevelopmental impairment or cognitive impairment in preterm infants treated with inhaled nitric oxide is similar to that of control infants (
Pediatrics 2013;133:164-170).