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NeoReviews Vol.9 No.12 2008 e555
© 2008 American Academy of Pediatrics

International Perspectives

Surfactant Without Assisted Ventilation: The Scandinavian Perspective

^* Department of Neonatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Abbreviations: a/A ratio: arterial-to-alveolar ratio • BPD: bronchopulmonary dysplasia • CPAP: continuous positive airway pressure • FiO₂: fraction of inspired oxygen • NICU: neonatal intensive care unit • nCPAP: nasal continuous positive airway pressure • RDS: respiratory distress syndrome • VLBW: very low birthweight

The first 300 words of the full text of this article appear below.

	A Strong Tradition of Continuous Positive Airway Pressure (CPAP)

 
Gregory and associates introduced CPAP for newborns in 1971. (1) At this time, ventilators were not designed for newborns, and mechanical ventilation was used only as an ultimate therapy, often with very poor outcome. The head chamber, or so-called Gregory box, rapidly gained interest around the world, and its effectiveness was striking, with mortality in respiratory distress syndrome (RDS) decreasing from 35% to 55% to 15% to 20%. (1) In the late 1970s and 1980s, infant ventilators developed rapidly. The focus for respiratory care of the newborn shifted toward mechanical ventilation, and the use of CPAP declined. In Scandinavia, however, the tradition of early CPAP was maintained. The Swedish anesthesiologist Gunnar Moa developed a CPAP device in which the pressure was generated by a jet of gas close to the nasal airway, which proved to be beneficial in reducing pressure variations and work of breathing. (2) This device later was developed into the Infant Flow Driver. In Denmark, a similar lightweight CPAP system with nasal prongs and a gas jet using the Benveniste valve has been predominant. Already in the late 1980s, the Danish neonatologist Jens Kamper reported successful treatment of very low-birthweight (VLBW) infants who had RDS using CPAP alone. (3) In a survey of all infants whose birthweights were less than 1,500 g born 1988 to 1993 in Stockholm, Sweden, 76% were managed with early CPAP or supplemental oxygen and only 24% received mechanical ventilation from birth. (4) Of infants primarily supported by early CPAP, approximately two thirds remained on CPAP as their only ventilatory support, never requiring mechanical ventilation.

	Early CPAP Rather Than Mechanical Ventilation?

 
The use of early nasal CPAP (nCPAP) has been linked to a favorable outcome in several epidemiologic studies, not only from Scandinavia. In 1987, Avery and colleagues (. . . [Full Text of this Article]

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