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Nasal continuous positive airway pressure and outcomes of preterm infants
1Department of Paediatrics, Middlemore Hospital, South Auckland, New Zealand. adeklerk@maimonidesmed.org
Insights
Switching to nasal continuous positive airway pressure (CPAP) support for preterm infants reduced respiratory support needs and adverse outcomes. This approach improved outcomes without increasing other morbidities, warranting further investigation.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Critical Care
Background:
- Preterm infants often require respiratory support, with traditional methods sometimes leading to adverse outcomes.
- The New York Presbyterian Hospital (Columbia University) developed a primarily nasal CPAP-based system for respiratory support.
Purpose of the Study:
- To evaluate the impact of transitioning to a nasal CPAP-based respiratory support system on preterm infants.
- To assess changes in respiratory and non-respiratory outcomes after implementing the new system.
Main Methods:
- A retrospective comparison of two groups of preterm infants (birthweight 1000-1499 g) over five years.
- Group I received conventional support; Group II received primarily nasal CPAP-based support.
Main Results:
- Significant reductions observed in mechanical ventilation (65% to 14%) and surfactant use (40% to 12%).
- Decreases in chronic lung disease (CLD) or death (16% to 3%), necrotizing enterocolitis (11% to 0%), and length of stay (61 to 52.9 days).
- No significant differences in neurosonographic or other morbidity outcomes were noted.
Conclusions:
- A nasal CPAP-based approach may reduce the invasiveness and duration of respiratory support for preterm infants.
- This method appears to decrease adverse respiratory and non-respiratory outcomes without increasing other morbidities.
- Further prospective trials are recommended to confirm these findings.
Objectives:
To document the effects of changing to a primarily nasal continuous positive airway pressure (CPAP)-based system of respiratory support on respiratory and non-respiratory outcomes in preterm infants.
Methodology:
Outcomes in two groups of preterm infants with a birthweight of 1000-1499 g were compared retrospectively over a 5-year period before (period I; n = 57) and after (period II; n = 59) the introduction of a primarily nasal CPAP-based approach to respiratory support, modelled closely on that used at the New York Presbyterian Hospital (Columbia University), formally known as the Columbia-Presbyterian Medical Center, in New York.
Results:
From period I to period II, there was a decline in the number of infants ventilated (65 vs 14%, respectively) and receiving surfactant (40 vs 12%, respectively) and in the median days of ventilation (6 vs 2, respectively) and oxygen (4 vs 2, respectively). There were decreases in chronic lung disease (CLD) at 28 days (11 vs 0%, respectively), death or CLD at 28 days (16 vs 3%, respectively), the use of pressor support (34 vs 7%, respectively), the incidence of necrotizing enterocolitis (11 vs 0%, respectively), time to reach full oral feeds (17.3 vs 13.2 days, respectively), discharge weight (2569 vs 2314 g, respectively) and average length of stay (61 vs 52.9 days, respectively). There were no differences in neurosonographic or other morbidity outcomes.
Conclusions:
A CPAP-based approach to respiratory support of the preterm infant may decrease the invasiveness and duration of respiratory support and may decrease respiratory and some non-respiratory adverse outcomes without an associated increase in neurosonographic or other morbidity outcomes. Further prospective trials are warranted.