Neurodevelopmental Outcomes and Health Care Utilization in Very Low Birth Weight Infants After Treatment With Bubble...

Background: Bronchopulmonary dysplasia (BPD) and prolonged invasive mechanical ventilation in preterm infants are associated with an increased risk for respiratory morbidity and adverse neurodevelopmental (ND) outcomes in early childhood. The use of nasal CPAP has been shown to reduce the duration of mechanical ventilation and risk for BPD. Bubble CPAP has physiologic properties that decrease lung injury, which may lead to better respiratory and developmental outcomes through prevention of BPD. To date, there is no study that reports the ND and health outcomes of infants treated with bubble CPAP. Methods: One hundred twenty infants treated with bubble CPAP were compared with 114 infants treated with infant flow driver (IFD) CPAP. Outcomes included Bayley-III scores, hospitalizations, emergency department visits, subspecialists, and therapies through the age of 2 years. Multiple regression analyses adjusted for effects of social and neonatal risk factors on outcomes. Results: Infants in the bubble CPAP group had lower rates of intubation (P = .02), need for surfactant administration (P < .001), and noninvasive ventilation (P < .001) as compared with infants treated with IFD CPAP. In extremely low birthweight infants (<1,000 g), treatment with bubble CPAP was predictive of higher cognitive scores at 20 months corrected age (CA) (P = .02). Conclusions: Use of bubble CPAP was associated with higher cognitive scores at 20 months CA in extremely low birthweight infants but not for infants with birthweight >1,000 g.