An experience with a bubble CPAP bundle: is chronic lung disease preventable?

Area of Science:

• Neonatalogy
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Continuous positive airway pressure (CPAP) offers a marginal decrease in chronic lung disease (CLD).
• Preterm infants often require respiratory support, increasing risks for CLD.
• A bubble CPAP (b-CPAP) bundle of care is a potential strategy to mitigate CLD.

Purpose of the Study:

• To evaluate the outcomes, specifically CLD incidence, in preterm infants managed with a b-CPAP bundle.
• To assess the feasibility and sustainability of the b-CPAP bundle in a clinical setting.
• To compare CLD rates with historical data and external benchmarks.

Main Methods:

• Infants under 1500g were grouped by intubation status within the first 3 days of life.
• Mortality, CLD, and other morbidities were analyzed across four chronological periods.
• Outcomes from the most recent period were compared to Vermont Oxford Network (VON) data.

Main Results:

• Out of 773 infants, 24.5% required intubation in the delivery room.
• The overall incidence of CLD was 6.4%, remaining consistent across epochs.
• CLD rates were significantly lower compared to VON benchmarks (p < 0.001).

Conclusions:

• A b-CPAP bundle of care is a feasible and sustainable method to reduce CLD in preterm infants.
• The study demonstrated significantly lower CLD rates compared to established benchmarks.
• Further cluster randomized trials are recommended to confirm the reproducibility of this b-CPAP approach.