Purpose
In the literature on sustainable supply chain management, the social pillar of sustainability has received relatively little attention, especially in developing countries. The purpose of this ...paper is to test empirically the impacts of supplier development practices on suppliers’ social performance. Furthermore, the impact of suppliers’ social performance on MNCs’ social performance was investigated and corporate reputation was proposed as a potential explanation for the relationship between MNCs’ social and financial performance.
Design/methodology/approach
Data were obtained from a survey of 141 multinational companies (MNCs) in Malaysia which were listed in the Federation of Malaysia Manufacturers’ directory 2017. Data were analyzed using partial least squares structural equation modeling.
Findings
The results show that among the four proposed practices, supplier development and supplier collaboration have significant effects on suppliers’ social performance and consequently on the multi-national companies’ social performance. According to these results, multi-national companies’ corporate reputation mediates the relationship between their social and financial performance.
Practical implications
These results will be useful in helping managers of MNCs to realize that simply monitoring suppliers and giving them incentives are not effective ways of enhancing social responsibility among suppliers; instead, supplier development and collaboration such as technical support and training are needed.
Originality/value
The results extend the literature on socially responsible supplier development practices by testing empirically the impacts of four popular practices in the literature and showing that supplier monitoring and incentives have no effect.
Radiological Spectrum of Pseudoangiomatous Stromal Hyperplasia of Breast—A Case Series Parameswaran, Prathiba Rajalakshmi; Renganathan, Rupa; Subramaniam, Prema ...
Indian journal of radiology and imaging - new series/Indian journal of radiology and imaging/Indian Journal of Radiology & Imaging,
12/2022, Letnik:
32, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal tumor-like lesion of the breast. It is commonly seen as incidental background changes of the intralobular stroma in ...biopsy specimens performed for other breast lesions. Less frequently, it presents as a nodular form that has a benign morphology on imaging, mimicking fibroadenoma or as a diffuse form causing progressive massive gigantomastia. Diagnosis is established by biopsy. Knowledge of the imaging appearance of PASH not only facilitates proper assessment of radiopathological correlation but also helps in deciding further management of these lesions. Occasionally, nodular PASH may have a suspicious appearance on imaging wherein excision biopsy is indicated to exclude a coexisting carcinoma.
Background
Contrast-enhanced MRI (CE MRI) of the breast is currently the most sensitive imaging technique for detecting invasive breast cancer, and it provides both morphologic and functional ...information through kinetics for characterizing breast masses. Contrast-enhanced mammography (CEM) uses the same principle of neo-angiogenesis to detect early cancers similar to MRI with comparable diagnostic performance. However, there is an important limitation in CEM in characterizing the breast lesions because of the non-availability of kinetic information. To the best of our knowledge, very few studies have assessed the CEM kinetics. In this study, we have evaluated the accuracy of subjective assessment of contrast kinetics in CEM and compared it with the subjective and quantitative kinetic assessment in CE MRI. If the performance of CEM is comparable to MRI, it may add an additional dimension to CEM in characterizing the breast masses in addition to detection.
Results
Kinetic information of 123 lesions in 90 patients was analyzed in CEM and MRI. Of these, 26 (21.1%) were benign, 4 (3.3%) were high risk lesions, and 93 (75.6%) were malignant breast lesions. Comparison of subjective and quantitative assessment in CE MRI had almost perfect agreement with a kappa value of 0.816, and both were used as reference standards for comparing CEM kinetics. Comparison of subjective assessment of kinetic patterns in CEM using only CC and MLO views showed moderate agreement with both quantitative (kappa − 0.483) and subjective (0.547) CE MRI kinetics. When the delayed image obtained at 8 min was included for kinetic analysis, CEM kinetics showed substantial to almost perfect agreement with quantitative (kappa − 0.673) and subjective (kappa − 0.855) CE MRI kinetics, respectively.
Conclusion
We hope that this study results would encourage the breast radiologist to assess the kinetic information from CEM and use CEM as a single, simple and cost-effective imaging modality in detecting and characterizing breast masses.
Background
Incidence of malignancy in architectural distortion (AD) is variable, and as a standard of care, all the architectural distortions are biopsied. It is important to identify benign and ...malignant characteristics of ADs on imaging to predict the probability of malignancies as well as to establish radiological–pathological concordance. The aim of our study was to analyse the utility of contrast-enhanced mammography (CEM) in primary AD, to describe and evaluate the accuracy of CEM parameters and derive a novel scoring system to differentiate benign and malignant AD.
Results
Forty-six patients with 49 ADs were evaluated with a median age, 51 years (age range—34–72 years) and all were women. Of the 49 ADs, 65.3% (32/49) were benign, and 34.69% (17/49) were malignant. The CEM parameters which predicted malignancy were moderate or marked density, size > 0.95 cm, CT ratio > 1.31, mass morphology and washout kinetics. The absence of enhancement and enhancing AD with AD score of 0 had a 100% NPV for malignancy. Enhancing architectural distortion with a score of 3 or more had 100% PPV for malignancy. A score of 1 or 2 was indeterminate, and an individualised decision was recommended.
Conclusions
In primary AD, several CEM features have significantly predicted malignancy when the score is 3 and above. A biopsy may be avoided in non-enhancing AD and enhancing AD with a score of 0 due to high NPV.
Key points
Incidence of malignancy in architectural distortion is variable and all are biopsied.
Contrast-enhanced mammography parameters and architectural distortion score helps to differentiate benign and malignant causes.
Biopsy can be avoided in non-enhancing architectural distortion and surgery should be advised when score is 3 and above even with benign histopathology results.
Retinopathy of prematurity (ROP) is an ophthalmic condition found in premature infants, characterized by abnormal vascular growth in the retina. This article provides a comprehensive review of ROP, ...including its historical developments, classification systems, treatment modalities and emerging therapies. The pathophysiology of ROP involves the underdeveloped retinal blood vessels, which can lead to impaired retinal vascularization and subsequent complications. The classification of ROP is crucial for determining appropriate treatment approaches, and this review describes the various classification systems used to categorize the disease based on severity and retinal involvement. Treatment options for ROP have evolved over time. This article discusses the use of Vitamin E supplementation, cryotherapy and photocoagulation using lasers. The Early Treatment ROP Study (ETROP) is highlighted as a pivotal study that demonstrated the effectiveness of laser treatment in preventing retinal detachments. Furthermore, the use of intravitreal anti-vascular endothelial growth factors (VEGF) agents is explored as a promising approach. In addition to established treatments, this review delves into emerging therapies and experimental approaches. It explores the potential use of erythropoietin, recombinant insulin-like growth factor-1, subcutaneous cyclic peptide antagonists, regulatory T cells and beta-adrenergic blockers. The article emphasizes the ongoing research efforts in these areas and their potential impact on future ROP management. In conclusion, this comprehensive review highlights the historical developments, classification systems, current treatment options and emerging therapies for ROP. Continued research and advancements in the field are necessary to optimize treatment strategies and mitigate the long-term effects of ROP.
Background
Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive ...respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Search methods
We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All randomised or quasi‐randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary.
Data collection and analysis
We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non‐tertiary hospitals; high income compared with low income)
Main results
We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial.
CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) –0.19, 95% CI –0.28 to –0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low‐certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD –0.13, 95% CI –0.25 to –0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low‐certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD –0.11, 95% CI –0.18 to –0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate‐certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low‐certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low‐certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood.
Authors' conclusions
In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource‐poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.
Background
Cohort studies have suggested that nasal continuous positive airways pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) ...may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV) and in preventing bronchopulmonary dysplasia (BPD) in preterm or low birth weight infants.
Objectives
To determine if prophylactic nasal CPAP started soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of bronchopulmonary dysplasia (BPD) without adverse effects.
Search methods
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 31 January 2016), EMBASE (1980 to 31 January 2016), and CINAHL (1982 to 31 January 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
All trials using random or quasi‐random patient allocation of very preterm infants (under 32 weeks' gestation) or less than 1500 grams at birth were eligible. We included trials if they compared prophylactic nasal CPAP started soon after birth regardless of the respiratory status of the infant with 'standard' methods of treatment such as IPPV, oxygen therapy or supportive treatment. We excluded studies where prophylactic CPAP was compared with CPAP along with other interventions.
Data collection and analysis
We used the standard methods of Cochrane and its Neonatal Review Group, including independent study selection, assessment of trial quality and extraction of data by two authors. Data were analysed using risk ratio (RR) and the meta‐analysis was performed using a fixed‐effect model.
Main results
Seven trials recruiting 3123 babies were included in the meta‐analysis. Four trials recruiting 765 babies compared CPAP with supportive care and three trials (2364 infants) compared CPAP with mechanical ventilation. Apart from a lack of blinding of the intervention all studies were of low risk of bias.
In the comparison of CPAP with supportive care there was a reduction in failed treatment (typical risk ratio (RR) 0.66, 95% confidence interval (CI) 0.45 to 0.98; typical risk difference (RD) −0.16, 95% CI −0.34 to 0.02; 4 studies, 765 infants, very low quality evidence). There was no reduction in bronchopulmonary dysplasia (BPD) or mortality.
In trials comparing CPAP with assisted ventilation with or without surfactant, CPAP resulted in a small but clinically significant reduction in the incidence of BPD at 36 weeks, (typical RR 0.89, 95% CI 0.79 to 0.99; typical RD −0.04, 95% CI −0.08 to 0.00; 3 studies, 772 infants, moderate‐quality evidence); and death or BPD (typical RR 0.89, 95% CI 0.81 to 0.97; typical RD −0.05, 95% CI −0.09 to 0.01; 3 studies, 1042 infants, moderate‐quality evidence). There was also a clinically important reduction in the need for mechanical ventilation (typical RR 0.50, 95% CI 0.42 to 0.59; typical RD −0.49, 95% CI −0.59 to −0.39; 2 studies, 760 infants, moderate‐quality evidence); and the use of surfactant in the CPAP group (typical RR 0.54, 95% CI 0.40 to 0.73; typical RD −0.41, 95% CI −0.54 to −0.28; 3 studies, 1744 infants, moderate‐quality evidence).
Authors' conclusions
There is insufficient evidence to evaluate prophylactic CPAP compared to oxygen therapy and other supportive care. However when compared to mechanical ventilation prophylactic nasal CPAP in very preterm infants reduces the need for mechanical ventilation and surfactant and also reduces the incidence of BPD and death or BPD.
Background
Cohort studies have suggested that nasal continuous positive airway pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) ...may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV), and in preventing bronchopulmonary dysplasia (BPD), in preterm or low birth weight infants.
Objectives
To determine if prophylactic nasal CPAP (started within the first 15 minutes) or very early nasal CPAP regardless of respiratory status (started within the first hour of life), reduces the use of mechanical ventilation and the incidence of bronchopulmonary dysplasia without any adverse effects in preterm infants.
Search methods
A comprehensive search was run on 6 November 2020 in the Cochrane Central Register of Controlled Trials (CENTRAL via CRS Web) and MEDLINE via Ovid. We also searched the reference lists of retrieved studies.
Selection criteria
We included all randomised controlled trials (RCTs) and quasi‐RCTs in preterm infants (under 37 weeks of gestation). We included trials if they compared prophylactic nasal CPAP (started within the first 15 minutes) or very early nasal CPAP (started within the first hour of life) in infants with minimal signs of respiratory distress with 'supportive care', such as supplemental oxygen therapy, standard nasal cannula, or mechanical ventilation. We excluded studies where prophylactic CPAP was compared with CPAP along with co‐interventions.
Data collection and analysis
We used the standard methods of Cochrane Neonatal, including independent study selection, assessment of trial quality, and extraction of data by two review authors.
Main results
We included eight trials (seven from the previous version of the review and one new study), recruiting 3201 babies, in the meta‐analysis. Four trials, involving 765 babies, compared CPAP with supportive care, and three trials (2364 babies) compared CPAP with mechanical ventilation. One trial (72 babies) compared prophylactic CPAP with very early CPAP. Apart from a lack of blinding of the intervention, we judged seven studies to have a low risk of bias. However, one study had a high risk of selection bias.
Prophylactic or very early CPAP compared to supportive care
There may be a reduction in failed treatment (risk ratio (RR) 0.6, 95% confidence interval (CI) 0.49 to 0.74; risk difference (RD) ‐0.16, 95% CI ‐0.34 to 0.02; 4 studies, 765 infants; very low certainty evidence). CPAP possibly reduces BPD at 36 weeks (RR 0.76, 95% CI 0.51 to 1.14; 3 studies, 683 infants, moderate certainty evidence); there may be little or no difference in death (RR 1.04, 95% CI 0.56 to 1.93; 4 studies, 765 infants; moderate certainty evidence). Prophylactic CPAP may reduce the composite outcome of death or BPD (RR 0.69, 95% CI 0.40 to 1.19; 1 study, 256 infants; low certainty evidence). There may be no difference in pulmonary air leak (pneumothorax) (RR 0.75, 95% CI 0.35 to 1.16; 3 studies, 568 infants; low certainty evidence), or intraventricular haemorrhage (IVH) Grade 3 or 4 (RR 0.96, 95% CI 0.39 to 2.37; 2 studies, 486 infants; moderate certainty evidence). Neurodevelopmental impairment was not reported in any of the studies.
Prophylactic or very early CPAP compared to mechanical ventilation
There was probably a reduction in the incidence of BPD at 36 weeks (RR 0.89, 95% CI 0.8 to 0.99; RD ‐0.04, 95% CI ‐0.08 to 0.00; 3 studies, 2150 infants; moderate certainty evidence); and death or BPD (RR 0.89, 95% CI 0.81 to 0.97; RD ‐0.05, 95% CI ‐0.09 to 0.01; 3 studies, 2358 infants; moderate certainty evidence). There was also probably a reduction in the need for mechanical ventilation (failed treatment) (RR 0.49, 95% CI 0.45 to 0.54; RD ‐0.50, 95% CI ‐0.54 to ‐0.45; 2 studies, 1042 infants; moderate certainty evidence). There was probably a reduction in the incidence of death (RR 0.82, 95% CI 0.66 to 1.03; 3 studies, 2358 infants; moderate certainty evidence); pulmonary air leak (pneumothorax) (RR 1.24, 95% CI 0.91 to 1.69; 3 studies, 2357 infants; low certainty evidence); and IVH Grade 3 or 4 (RR 1.09, 95% CI 0.86 to 1.39; 3 studies, 2301 infants; moderate certainty evidence). One study in this comparison reported that there was probably little or no difference between the groups in the incidence of neurodevelopmental impairment at 18 to 22 months (RR 0.91, 95% CI 0.62 to 1.32; 976 infants; moderate certainty evidence).
Prophylactic CPAP compared with very early CPAP
There was one study in this comparison. We are very uncertain whether there is any difference in the incidence of BPD (RR 0.5, 95% CI 0.05 to 5.27; very low certainty evidence). The combined outcome of death and BPD was not reported, and failed treatment was reported but without data. There may have been little to no effect on death (RR 0.75, 95% CI 0.29 to1.94; 1 study, 72 infants; very low certainty evidence). Intraventricular haemorrhage Grade 3 or 4 and neurodevelopmental outcomes were not reported in this study. Pulmonary air leak (pneumothorax) was reported in this study, but there were no events in either group.
Authors' conclusions
For preterm and very preterm infants, there is insufficient evidence to evaluate prophylactic CPAP compared to oxygen therapy and other supportive care. When compared to mechanical ventilation, prophylactic nasal CPAP in very preterm infants reduces the incidence of BPD, the combined outcome of death and BPD, and mechanical ventilation. There is probably no difference in neurodevelopmental impairment at 18 to 22 months of age.
When prophylactic CPAP is compared to early CPAP, we are very uncertain about whether there is any difference between prophylactic and very early CPAP.
There is no information about the effect of prophylactic or very early CPAP in late preterm infants.
There is one study awaiting classification.
Background
The application of continuous positive airway pressure (CPAP) has been shown to have some benefits in the treatment of preterm infants with respiratory distress. CPAP has the potential to ...reduce lung damage, particularly if applied early before atelectasis has occurred. Early application may better conserve an infant's own surfactant stores and consequently may be more effective than later application.
Objectives
• To determine if early compared with delayed initiation of CPAP results in lower mortality and reduced need for intermittent positive‐pressure ventilation in preterm infants in respiratory distress
○ Subgroup analyses were planned a priori on the basis of weight (with subdivisions at 1000 grams and 1500 grams), gestation (with subdivisions at 28 and 32 weeks), and according to whether surfactant was used
▫ Sensitivity analyses based on trial quality were also planned
○ For this update, we have excluded trials using continuous negative pressure
Search methods
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literatue (CINAHL), on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi‐RCTs.
Selection criteria
We included trials that used random or quasi‐random allocation to either early or delayed CPAP for spontaneously breathing preterm infants in respiratory distress.
Data collection and analysis
We used the standard methods of Cochrane and Cochrane Neonatal, including independent assessment of trial quality and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence.
Main results
We found four studies that recruited a total of 119 infants. Two were quasi‐randomised, and the other two did not provide details on the method of randomisation or allocation used. None of these studies used blinding of the intervention or the outcome assessor. Evidence showed uncertainty about whether early CPAP has an effect on subsequent use of intermittent positive‐pressure ventilation (IPPV) (typical risk ratio (RR) 0.77, 95% confidence interval (CI) 0.43 to 1.38; typical risk difference (RD) ‐0.08, 95% CI ‐0.23 to 0.08; I² = 0%, 4 studies, 119 infants; very low‐certainty evidence) or mortality (typical RR 0.93, 95% CI 0.43 to 2.03; typical RD ‐0.02, 95% CI ‐0.15 to 0.12; I² = 33%, 4 studies, 119 infants; very low‐certainty evidence). The outcome 'failed treatment' was not reported in any of these studies. There was an uncertain effect on air leak (pneumothorax) (typical RR 1.09, 95% CI 0.39 to 3.04, I² = 0%, 3 studies, 98 infants; very low‐certainty evidence). No trials reported intraventricular haemorrhage or necrotising enterocolitis. No cases of retinopathy of prematurity were reported in one study (21 infants). One case of bronchopulmonary dysplasia was reported in each group in one study involving 29 infants. Long‐term outcomes were not reported.
Authors' conclusions
All four small trials included in this review were performed in the 1970s or the early 1980s, and we are very uncertain whether early application of CPAP confers clinical benefit in the treatment of respiratory distress, or whether it is associated with any adverse effects.
Further trials should be directed towards establishing the appropriate level of CPAP and the timing and method of administration of surfactant when used along with CPAP.
Background
Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent ...positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition, but it is invasive, potentially resulting in airway and lung injury. Continuous distending pressure (CDP) has been used for the prevention and treatment of RDS, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae.
Objectives
To determine the effect of continuous distending pressure (CDP) on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.
Subgroup analyses were planned on the basis of birth weight (> or < 1000 or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), methods of application of CDP (i.e. CPAP and CNP), application early versus late in the course of respiratory distress and high versus low pressure CDP and application of CDP in tertiary compared with non‐tertiary hospitals, with the need for sensitivity analysis determined by trial quality.
At the 2008 update, the objectives were modified to include preterm infants with respiratory failure.
Search methods
We used the standard search strategy of the Neonatal Review Group. This included searches of the Oxford Database of Perinatal Trials, the Cochrane Central Register of Controlled Trials (CENTRAL, 2015 Issue 4), MEDLINE (1966 to 30 April 2015) and EMBASE (1980 to 30 April 2015) with no language restriction, as well as controlled‐trials.com, clinicaltrials.gov and the International Clinical Trials Registry Platform of the World Health Organization (WHO).
Selection criteria
All random or quasi‐random trials of preterm infants with respiratory distress were eligible. Interventions were continuous distending pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharyngeal tube or endotracheal tube, or continuous negative pressure (CNP) via a chamber enclosing the thorax and the lower body, compared with spontaneous breathing with oxygen added as necessary.
Data collection and analysis
We used standard methods of The Cochrane Collaboration and its Neonatal Review Group, including independent assessment of trial quality and extraction of data by each review author.
Main results
We included six studies involving 355 infants ‐ two using face mask CPAP, two CNP, one nasal CPAP and one both CNP (for less ill babies) and endotracheal CPAP (for sicker babies). For this update, we included no new trials.
Continuous distending pressure (CDP) is associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.65, 95% confidence interval (CI) 0.52 to 0.81; typical risk difference (RD) ‐0.20, 95% CI ‐0.29 to ‐0.10; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 4 to 10; six studies; 355 infants), lower overall mortality (typical RR 0.52, 95% CI 0.32 to 0.87; typical RD ‐0.15, 95% CI ‐0.26 to ‐0.04; NNTB 7, 95% CI 4 to 25; six studies; 355 infants) and lower mortality in infants with birth weight above 1500 g (typical RR 0.24, 95% CI 0.07 to 0.84; typical RD ‐0.28, 95% CI ‐0.48 to ‐0.08; NNTB 4, 95% CI 2.00 to 13.00; two studies; 60 infants). Use of CDP is associated with increased risk of pneumothorax (typical RR 2.64, 95% CI 1.39 to 5.04; typical RD 0.10, 95% CI 0.04 to 0.17; number needed to treat for an additional harmful outcome (NNTH) 17, 95% CI 17.00 to 25.00; six studies; 355 infants). We found no difference in bronchopulmonary dysplasia (BPD), defined as oxygen dependency at 28 days (three studies, 260 infants), as well as no difference in outcome at nine to 14 years (one study, 37 infants).
Authors' conclusions
In preterm infants with respiratory distress, the application of CDP as CPAP or CNP is associated with reduced respiratory failure and mortality and an increased rate of pneumothorax. Four out of six of these trials were done in the 1970s. Therefore, the applicability of these results to current practice is difficult to assess. Further research is required to determine the best mode of administration.
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