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Impact of the shift to neonatal noninvasive ventilation in Poland: a population study
M Wilinska1, T Bachman, J Swietlinski
11Department of Neonatology, The Medical Centre of Postgraduate Education, Warsaw, Poland. 2Department of Administration, Mountains Community Hospital, Lake Arrowhead, CA. 3Department of Neonatology, Medical University, Wroclaw, Poland. 4Department of Neonatology, The Voivodal Hospital, Olsztyn, Poland. 5Department of Neonatology, National Research Institute of Mother and Child, Warsaw, Poland. 6Department of Neonatology, Medical University of Warsaw, Warsaw, Poland. 7Department of Neonatology, University of Medical Sciences, Poznan, Poland. 8Department of Neonatology, Medical College Jagiellonian University of Krakow, Krakow, Poland. 9Department of Quantitative Methods and Information Systems, Warsaw School of Economics, Warsaw, Poland.
Insights
Implementing noninvasive ventilation in Poland significantly reduced neonatal mortality. This shift in practice improved outcomes for premature infants without increasing pulmonary or retinal complications.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Practice Improvement
Background:
- Neonatal respiratory support is critical for premature infants.
- Traditional invasive ventilation carries risks.
- Noninvasive ventilation offers a potentially safer alternative.
Purpose of the Study:
- To evaluate the impact of a widespread shift to noninvasive respiratory support in neonatal intensive care units.
- To assess changes in mortality and morbidity following the implementation of a new standard of care.
Main Methods:
- A before-after observational study was conducted across 18 neonatal ICUs in Poland.
- Data were collected over a 7-year period, including a 12-month transition phase.
- Infants requiring respiratory support were analyzed, with a focus on gestational age.
Main Results:
- The use of noninvasive ventilation as initial support increased by 19% (p < 0.001).
- Weaning with noninvasive support increased by 32% (p = 0.06), most notably in infants ≤32 weeks gestational age (p < 0.001).
- Mortality decreased from 11% to 7% (p < 0.001), particularly in infants ≤32 weeks gestational age. Bad outcomes in survivors did not increase (p = 0.669).
Conclusions:
- Adoption of noninvasive ventilation significantly decreased neonatal mortality.
- This approach did not lead to an increase in severe bronchopulmonary dysplasia or retinopathy of prematurity.
- Emphasizing noninvasive ventilation represents a successful strategy for improving neonatal outcomes.
Objective:
This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support.
Design:
Before-after observational study.
Setting:
All 18 neonatal ICUs in the capital region of Poland.
Patients:
Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after).
Intervention:
Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems.
Measurements And Main Results:
Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables.
Conclusions:
We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.
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