Early CPAP protocol in preterm infants with gestational age between 28 and 32 weeks: experience of a public hospital.

• The "early CPAP" protocol was implemented using intermediate pressures of 6–7 cmH 2 O. • A decrease in intubation rate and days of invasive ventilation were observed. • A reduction of exogenous surfactant use and length of hospital stay were observed. • The protocol used simple and affordable equipment and could be reproduced. The use of continuous positive airway pressure (CPAP) applied early after birth improves several outcomes when compared with intubation and invasive mechanical ventilation. "Early CPAP" protocols vary in relation to the pressure level, type of interface used, and studied sample. This study compared intubation rate, exogenous surfactant use, and hospitalization length (among other variables) prior to and after adopting an "early CPAP" protocol in preterm infants with gestational age between 28 and 32 weeks, using intermediate pressures and short binasal prongs. This was a retrospective study conducted in a public university hospital in Brazil. All preterm infants with gestational age between 28 and 32 weeks were included in the study. The newborns born between January 2011 and December 2012, prior to the protocol being implemented, were considered the historical control group, and those born after implementation, between February 2013 and August 2014 were considered the intervention group. The participants in both groups had similar baseline characteristics (p > 0.05). There were significant reductions in intubation rate (89% versus 73%, p = 0.02), exogenous surfactant use (86% versus 67%, p = 0.02), and median (Q1 - Q3) days of invasive mechanical ventilation [4 (2 - 14) versus 1 (0.15–9), p = 0.01] and length of hospital stay in days [56 (42–77) versus 42 (35–71), p = 0.02]. The findings demonstrate positive outcomes of the early CPAP protocol. This protocol used simple and affordable equipment available in the hospital which could easily be reproduced in other centers, generating better outcomes for preterm infants and reducing hospital expenses. [ABSTRACT FROM AUTHOR]