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Bubble Nasal Continuous Positive Airway Pressure, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very Low Birth Weight Newborns: Efficacy and Safety Considerations.
MedLine Citation:
PMID:  23106970     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very low birth weight (VLBW) newborns reduces lung damage. This study sought to determine if introduction of bubble nasal continuous positive airway pressure (bnCPAP), early surfactant treatment and rapid extubation (combined bnCPAP strategy) in our community-based neonatal intensive care unit (NICU) reduced bronchopulmonary dysplasia (BPD). METHODS: Seven-year retrospective, single institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model. RESULTS: The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4%, P = 0.018, reaching a minimum in the last post-bnCPAP year of 22.1%, P = 0.022. When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD, P = 0.003 (OR 0.43, 95% CI 0.25 to 0.75). Decreases occurred in mechanical ventilation, the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely low birth weight (ELBW) newborns improved respiratory outcomes in the post-bnCPAP years as compared to outcomes in the pre-bnCPAP years included an increase in the percentage alive and off mechanical ventilation at one-week postnatal age, P < 0.0001; a more rapid extubation rate, P < 0.025; a decrease in the median days on mechanical ventilation, P = 0.002; and a decrease in the percentage with BPD or died, P = 0.012. Post-bnCPAP ELBW babies had a statistically significant decrease in retinopathy of prematurity, an increase in lowgrade intraventricular hemorrhage, and a decrease in ductal ligations. CONCLUSIONS: A combined BnCPAP strategy may contribute to a reduction of BPD after adjusting for concurrent treatments.
Authors:
Charles A Friedman; Robert C Menchaca; Mary C Baker; Clarissa K Rivas; Raymond N Laberge; Enrique H Rios; Syed H Haider; Edgar J Romero; Elizabeth B Eason; J Kennard Fraley; Mesfin Woldesenbet
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-26
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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