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Interventions for the Management of Respiratory Distress in Late Preterm and Term Infants Experiencing Delayed Respiratory Transition

A Systematic Review

Bedwell, Susan, DNP, APRN, CCNS-N; Leasure, A. Renee, PhD, RN, CCRN; Gibson, Theresa L., MSN, MBA, RNC-OB

Dimensions of Critical Care Nursing: July/August 2019 - Volume 38 - Issue 4 - p 192–200
doi: 10.1097/DCC.0000000000000365
Educational DIMENSION

Objectives To examine the best available evidence for interventions used to manage mild to moderate respiratory distress in late preterm and term infants experiencing delayed respiratory transition.

Data Sources EMBASE, MEDLINE, Cochrane Review, Joanna Briggs, PubMed, CINAHL, and Google Scholar online databases were searched for articles related to delayed respiratory transition. Reference lists were reviewed to identify additional articles for inclusion.

Study Selections Randomized, blinded, placebo-controlled, randomized prospective, prospective observational, and retrospective cohort studies published in English-language, peer-reviewed journals between 2007 and August 2017 were reviewed for inclusion. Studies were included if they examined respiratory focused interventions that could potentially prevent admission to the neonatal intensive care unit (NICU) of the term or late preterm infant transitioning to extrauterine life.

Data Extraction The CASP tools were utilized for appraisal of individual studies. Data were extracted from the 5 studies included in this review.

Data Synthesis In 4 of the 5 studies, prevention of NICU admission was the primary aim. The observational study observed videos of newborn resuscitations and described the effect of early intervention with continuous positive-airway pressure (CPAP) ventilation on prevention of NICU admission for respiratory distress. One randomized controlled trial used adrenaline injections to prevent development of respiratory distress. The 3 remaining randomized controlled trials used prophylactic CPAP or sustained inflation as a method for preventing development of delayed respiratory transition. Three of the 5 studies focused exclusively on cesarean born infants. Among the interventions studied, early or prophylactic CPAP shows the most promise for prevention of NICU admission in late preterm and term infants with mild to moderate respiratory distress.

Conclusion The lack of safety and efficacy data for either adrenaline injections or prophylactic CPAP precludes either method for current use in the prevention of respiratory distress for the late preterm or term infant transitioning to extrauterine life. Two randomized trials, both using prophylactic CPAP, had a significant decrease in NICU admissions. Both studies were conducted at a single center and exclusive to infants born by cesarean delivery. A single study using sustained lung inflation showed no significant difference in the need for respiratory support or NICU admission. A single study using adrenaline also showed no benefit to the prevention of respiratory distress related to transition. Further multicenter randomized controlled trials are needed before broad adoption of early or prophylactic CPAP can be recommended.

Susan Bedwell, DNP, APRN, CCNS-N, is a board-certified, neonatal critical care clinical nurse specialist with 30 years of neonatal intensive care unit experience. She has been involved in several neonatal research studies including studies on ventilator-associated pneumonia, retinopathy of prematurity, intraventricular hemorrhage, and sibling visits and infection rates in the neonatal intensive care unit. Dr Bedwell has presented her work at more than 25 conferences and has several publications.

A. Renee Leasure, PhD, RN, CCRN, is an associate professor at the Fran and Earl Ziegler College of Nursing at the University of Oklahoma Health Sciences Center. She has published several articles and presented her work focused on topics relevant to the practice of critical care nursing locally, nationally, and internationally.

Theresa L. Gibson, MSN, MBA, RNC-OB, Theresa L. Gibson, MSN, MBA, RNC-OB, is the director of Women's Services with 20 years of experience in the mother-infant dyad within Women's Services and has been an integral part of quality improvement projects improving outcomes for postpartum hemorrhage, oxytocin (Pitocin) use for inductions, and preventing unnecessary neonatal intensive care unit admissions

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Susan Bedwell, DNP, APRN, CCNS-N, 1200 Everett Dr Suite 5271, Oklahoma City, OK 73104 (

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