Article Text

BUBBLE CONTINUOUS POSITIVE AIRWAY PRESSURE REDUCES THE DURATION OF CONVENTIONAL MECHANICAL VENTILATION AMONG VERY LOW BIRTH WEIGHT INFANTS WITH RESPIRATORY DISTRESS SYNDROME
  1. T Nowadzky1,
  2. A Pantoja1,2,
  3. J R Britton1,2
  1. 1Department of Neonatology, Exempla St Joseph Hospital, Denver, Colorado, USA
  2. 2Department of Neonatology, Kaiser Permanente, Denver, Colorado, USA

Abstract

Objective Because prolonged mechanical ventilation is associated with chronic lung disease and long-term neurodevelopmental impairment among very low birth weight (VLBW) infants, we assessed the efficacy of bubble nasal continuous positive airway pressure (CPAP) to reduce the use of conventional mechanical ventilation among these infants.

Methods During two sequential time periods (period 1: 1 January 2003–28 February 2005; period 2: 1 March 2005–4 October 2007), VLBW infants with respiratory distress syndrome were treated with either conventional nasal CPAP (N  =  88) or bubble nasal CPAP (N  =  126). Infants at both time periods were similar with respect to gestational age, birth weight, gender, ethnicity, prenatal steroid treatment and other aspects of perinatal care. Pulmonary and non-pulmonary outcomes were compared for the two time periods.

Results The mean duration (+SEM) of ventilation during period 2 was shorter than during period 1 (3.08 + 0.55 vs 5.25 + 0.87 days, p = 0.017), and fewer infants during period 2 required ventilation for greater than 6 days compared with those in period 1 (13.6% vs 26.3%, p = 0.008). In regression models, the effect of period 2 persisted after controlling for other predictors of duration of ventilation. There were no significant differences in other pulmonary or non-pulmonary outcomes, with the exception of mild retinopathy of prematurity (ROP; stages I or II), which was more common during period 2. The enhanced odds of ROP persisted after controlling for other known predictors of this condition.

Conclusion Among VLBW infants with respiratory distress syndrome, the use of bubble nasal CPAP may reduce the use of ventilation. However, an increased risk of ROP may be incurred.

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