Assessment of the CPAP standardized protocol in the delivery room on the long-term outcomes of cerebral pathology: a cohort study

Despite the rapid relief of respiratory disorders in transient tachypnea of the newborn (TTN) in most of the cases, these patients keep showing evidence of changes in the level of cerebral oxygenation and activity of neurotrophic factors as well as a high frequency of the “cerebral ischemia” (CI) diagnosis at discharge. There are no current data on the frequency of cerebral damage in patients with a history of TTN in the long term. The purpose of this research was to evaluate the effectiveness of the CPAP standardized protocol in the delivery room on the long-term outcomes of cerebral pathology (CP). Materials and methods used: a single-center cohort retrospective study was conducted that included both full-term and late preterm patients with TTN, both before the introduction of the CPAP standardized protocol in the delivery room and after the its implementation. The follow-up data of the full-term infants - for the first two years of life (2020, 2021, 2022, 2023) and of the premature infants - for the first one year of life (2020 and 2022, 2023) were collected. The frequency and the nature of the identified CP were assessed. Results: the full-term follow-up control (FFC) group consisted of 116, the full-term follow-up study (FFS) group of 84, the premature follow-up control (PFC) group of 60 and the premature follow-up study (PFS) group of 50 children. In the FFS group the CP was statistically significantly less frequently diagnosed at 6, 9, 12 months, 1.5 and 2 years of life in contrast to the FFC group (p<0.05). In the PFS group the CP was also statistically significantly less frequently diagnosed, but only at the age of 1 year of life, unlike the PFC group (p˂0.05). However, the results of the study do not exclude a high frequency of hyperdiagnosis that requires the introduction of a standardized approach. Conclusion: the study showed that standardization of the primary respiratory strategy in the delivery room, CPAP implementation according to the protocol that the Aurors have developed, leads to a decrease in the frequency of CP not only upon discharge from the perinatal center, but also in the long term. Authors see the introduction of the protocol into the maternity hospitals’ routine practice as one of the important steps in the strategy for protecting and maintaining children's health.