Use of Continuous Positive Airway Pressure in Preterm Infants: Comments and Experience From New Zealand

* Abbreviations: CPAP = : continuous positive airway pressure • CLD = : chronic lung disease • NICU = : neonatal intensive care unit • VLBW = : very low birth weight The role of continuous positive airway pressure (CPAP) in the care of preterm newborns with respiratory disease has long been debated in the neonatal literature, with much early interest focused on the multicenter study of Avery et al.1 This study demonstrated a significantly lower incidence of chronic lung disease (CLD) in preterm infants at 28 days of life at Columbia Presbyterian Medical Center in New York, a center that used CPAP extensively. Despite valid criticisms of the limitations of that multicenter observational study design and a lack of good quality studies looking at the role of CPAP versus other respiratory support in the interim, interest has been rekindled by, among others, the recent study of Van Marter et al.2 This again revealed a substantially lower incidence of CLD at Columbia versus 2 centers in Boston, in this case at 36 weeks' corrected gestational age. Additional analysis showed that despite multiple variations in details of care and respiratory support, neonatal intensive care unit (NICU)-specific risk of CLD was predominantly associated with the decision to use mechanical ventilation. A number of questions have arisen, many of which can be answered at best only in part, and some not at all. 1. Is the success with CPAP of the Columbia group reproducible at other centers? In a recent paper,3 the authors report in a historical cohort study the results of rigorously introducing a Columbia model of respiratory support into a Level 3 NICU (Middlemore Hospital) in Auckland, New Zealand, that previously practiced … Address correspondence to Alan M. de Klerk, MBChB, Department of Pediatrics, Infants' and Children's Hospital of Brooklyn at Maimonides, 4802 10th Ave, Brooklyn, NY 11219. E-mail:adeklerk{at}maimonidesmed.org