Two-Step Mask Continuous Positive Airway Pressure Improves Transient Tachypnea of the Newborn

Background: Recent studies indicate mask continuous positive airway pressure (mCPAP) improves the neonatal respiratory stabilization. However, it is not clear whether mCPAP is effective against term infants with transient tachypnea of the newborn (TTN) delivered by elective cesarean section (eCS). In December 2017, we decided to treat central cyanotic and forced breathing term infants delivered by eCS with mCPAP in theater within 15 minutes, instead of administering oxygen. Moreover, we transferred the infants to the treatment room and treated them with mCPAP until 60 minutes after birth, if their central cyanosis and forced breathing either appeared or was prolonged.

Objective: The objective of this study was to evaluate whether two-step mCPAP until 60 minutes after birth is effective for decreasing the number of term infants hospitalized for TTN delivered by eCS.

Methods: Among infants with 36 weeks of gestation and more who were delivered by eCS in our hospital, we retrospectively compared 160 delivered from 1 December 2016 to 30 October 2017 (Oxygen Group) with 161 delivered from 1 December 2017 to 30 October 2018 (MC Group).

Results: Baseline characteristics of all infants were comparable, but the Apgar score at 5 minutes was statistically less in the MC Group than in the Oxygen Group (9.0, p<0.05). Oxygen administration was statistically less in the MC Group than in the Oxygen Group (12/160 vs 57/161, p<0.01) and mCPAP was used statistically more often in the MC Group than in the Oxygen Group (54/160 vs 0/161, p<0.01). The number of infant hospitalized for TTN in the MC Group was significantly less than in the Oxygen Group (17/161 vs 5/161, p<0.05).

Conclusion: Two-step mCPAP until 60 minutes after birth might decrease the number of term infants hospitalized for TTN delivered by eCS.