Background Intubation and mechanical ventilation (MV) are life-saving procedures but are associated with a higher incidence of acute and chronic complications. Thus, non-invasive ventilation (NIV: nasal continuous pulmonary distending pressure, nasal ventilation, or high-flow nasal cannula) is increasingly used.
Aim To evaluate changes in ventilatory strategies between 2006 and 2010 in Italian neonatal network (INN).
Methods A cohort of neonates < 30 weeks gestational age (GA) or < 1501 g birth weight (BW), without congenital anomalies, born in 2006 and 2010, assisted in 31 hospitals participating in INN both years, was analysed (N=3459: 1713 in 2006, and 1746 in 2010). Variables were defined according to Vermont-Oxford network. Logistic regressions, adjusting for confounders (GA, BW for GA, antenatal steroids, mode of delivery, multiple pregnancy, 1-minute Apgar score, being inborn, sex, intubation in delivery room, RDS, PDA), and clustering for hospitals, were used.
Results Between 2006 and 2010 there were no changes in GA or BW (2006: mean GA 29.1 wks; BW 1087 g; 2010: GA 29.2 wks; BW 1083 g), while antenatal steroids increased (from 78.5% to 83.5%). The number of infants receiving any ventilatory support increased from 81.8% to 85.9%. After adjusting for confounders, mortality decreased (Odds ratio=0.75, 95% confidence interval 0.57–0.98) as well as mechanical ventilation (OR=0.72, 95%CI 0.57–0.90) and BPD (OR=0.68, 95%CI 0.54–0.86), while NIV increased (OR= 1.70, 95%CI 1.41–2.04).
Conclusions In the last 5 years, we observed a reduction of MV and an increase of NIV use. This was accompanied by a decrease in risk-adjusted mortality and BPD.