MINITOUCH TREATMENT OF VERY-LOW-BIRTH-WEIGHT INFANTS

In a cohort study with historical controls of non-asphyxiated very low-birth-weight infants (birth weight less-than-or-equal-to 1500 g and gestational age < 33 completed weeks), we evaluated the use of a ''minitouch'' regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. The frequency of mechanical ventilation was reduced significantly from 76% in 1985 to 35% in 1987 (p = 0.00001). This reduction reflected the smaller number of infants who received ventilator treatment for less than one week, whereas the frequency of long-term ventilator treatment remained unchanged. Intracranial haemorrhage grade II-IV was reduced from 49% in 1985 to 25% in 1987 (p = 0.01). Mortality rate, average duration of hospitalization, number of infants with pneumothorax, patent ductus arteriosus, need for oxygen at 28 days and number of surviving infants with handicap did not differ significantly between the two study periods. Septicaemia was diagnosed in 16% of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parenteral nutrition (18% in 1987 versus 3% in 1985, p = 0.007). We conclude that the minitouch regime prevents progression of respiratory distress, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems. The infants need to be monitored continuously to recognize respiratory insufficiency demanding ventilator treatment.