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Preterm infants failing on CPAP show respiratory fatigue at birth

Background: Continuous positive airway pressure (CPAP) is used to stabilise preterm infants at birth, but many develop respiratory distress and later require increased support. We investigated whether breathing pattern and effort at birth is different for infants who fail CPAP <48 hours after birth. Methods: Respiratory function recordings of 32 preterm infants were reviewed (15 failed CPAP). Frequency and duration of expiratory holds (EHs) and tidal volumes (VT), peak inspiratory flows, CPAP-level and FiO 2 -levels were analysed. Results: EH incidence increased <6 minutes after birth and remained stable thereaf-ter. EH peak inspiratory flows and VT were similar between CPAP-fail and CPAP-success infants. At 9-12 mins, CPAP-fail infants more frequently used smaller VTs, 0-9ml/kg and required higher peak inspiratory flows. However, CPAP-success infants often used large VTs (>9 ml/kg) with higher peak inspiratory flows than CPAP-fail infants (71.8±15.8 vs. 15.5±5.2 ml/kg.s, p<0.05). CPAP-fail infants required higher FiO 2 (0.31±0.03 vs. 0.21±0.01), higher CPAP pressures (6.62±0.3 vs. 5.67±0.26 cmH 2 O) and more positive pressure-deliv-ered breaths (45±12 vs 19±9%) (p<0.05) Conclusion: At 9-12 minutes after birth, CPAP-fail infants more commonly used lower VTs and required higher peak inspiratory flow rates while receiving greater respiratory support. VT were less variable and larger VT were infrequently used reflecting early signs of fatigue. respiratory acidosis (pH < 7.25 and pCO 2 >60 mmHg and rising) on two separate blood gases. Results are presented as mean ± standard error of the mean or otherwise stated. Data were tested for normality and equal variance and data transformations were performed if necessary using SigmaPlot (SigmaPlot 12, Systat Software Inc. Chicago, Illinois). A Stu-dent-Newman-Keuls post hoc test was performed to identify statistical differences. A p-value of <0.05 was used for statistical significance. When Student’s t-tests were used to compare groups, data that were not normally distributed were analysed using a Mann-Whitney Rank Sum test.