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2005 Abstracts
122
DOES THE INTRODUCTION OF NASAL CPAP IMPROVE RESPIRATORY OUTCOMES IN PREMATURE INFANTS?
G Pelligra, MA Abdellatif, SK Lee
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
BACKGROUND: Nasal CPAP (nCPAP) is widely used for a range of neonatal respiratory conditions. It is established as an effective method of preventing extubation failure and in the management of apnea of prematurity. Despite the lack of evidence, nCPAP has been introduced in neonatology practice as an alternative to intubation and mechanical ventilation in infants with respiratory distress syndrome, based on the assumption that nCPAP will produce a significant decrease in adverse respiratory outcomes.
OBJECTIVE: To determine changes in the use of mechanical ventilation and incidence of bronchopulmonary dysplasia (BPD), defined as need for supplemental oxygen at 28 days old, subsequent to the increased use of nCPAP.
DESIGN/METHODS: Data from n=2002 neonates, with gestational age <32 weeks, admitted to the NICU at BC Children's Hospital between June 1996 and August 2004 and followed prospectively until death or discharge from hospital were analyzed. Characteristics of the study population, respiratory therapies and respiratory outcomes were compared between 2 consecutive time periods (Period 1: June 1996-May 2000; and Period 2: June 2000-August 2004), before and after introduction of early nCPAP in our NICU.
RESULTS: Characteristics of the study population between the 2 periods were similar, except for proportion of outborns (18% vs 23%, p=0.005) and deliveries by caesarean section (49% vs 56%, p=0.001). A significant increase in the use of nCPAP was noted between Period 1 to 2 (53% vs 63%, p<0.001), as well as a significant reduction in the use of exogenous surfactant (51% vs 42%, p<0.001) and need for mechanical ventilation (79% vs 65%, p<0.001). There was a significant reduction in the incidence of BPD (34% vs 28%, p=0.007). The difference persisted after adjustment for death (44% vs 37%, p=0.001). The number of infants who required supplemental oxygen at 36 weeks postconceptional age did not differ between groups (12% vs 14%, p=0.1).
CONCLUSIONS: A significant increase in nCPAP therapy in our unit has been associated with a decrease in the use of more invasive therapies. Incidence of BPD has also decreased, although the number of infants who remain on supplemental oxygen at 36 weeks postconceptional age did not change.