Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

Fischer, Hendrik; Bührer, Christoph

doi:10.1542/peds.2013-1880

Cited by 259 publications

(182 citation statements)

References 80 publications

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“…26 Secondary outcomes included frequency of delivery room CPAP (goal of increasing frequency), and intubation and surfactant administration in the delivery room (goal of reducing frequency, which may help to prevent bronchopulmonary dysplasia). 27 The CPQCC data set was the source of measurement; these data are collected by trained abstractors by using standard definitions and methods. 23 Balancing measures included (1) hyperthermia (temperature .37.5°), (2) the need for epinephrine and chest compressions, and (3) pneumothorax rates.…”

Section: Study Outcomesmentioning

confidence: 99%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group. WHAT THIS STUDY ADDS:A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. abstract BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS:This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS:Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

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Section: Study Outcomesmentioning

confidence: 99%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

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“…Some studies showed that there was no clear demonstration of a reduction of bronchopulmonary dysplasia (BPD) with the use of noninvasive ventilation [7][8][9][10]. However, recent meta-analysis made by Schmolzer [11] and Fischer [12] demonstrated that there is a statistically significant advantage in the use of non-invasive ventilation regarding death and BPD.…”

Section: Introductionmentioning

confidence: 99%

Nasal Bilevel Versus Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Aguiar¹,

Macedo²,

Voutsen³

et al. 2015

J Clin Trials

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Objective: We designed a study with a primary objective of comparing the effectiveness of nasal continuous positive airway pressure (nCPAP) versus bi-level CPAP (BiPAP) as the primary mode of non-invasive ventilation in preterm newborns. The primary outcome was need for invasive ventilation in the first 120 hours of life. The secondary objective was to compare these two groups regarding duration of non-invasive ventilation, use of surfactant, incidence of pneumothorax, bronchopulmonary dysplasia (BPD), peri and intraventricular haemorrhage (PIVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, length of hospitalisation and mortality.Methods: Prospective, multicentre clinical trial enrolling 220 neonates born at 27 to 32+6 weeks of gestation randomly assigned at birth for either CPAP or BiPAP. Results:One hundred and nine neonates received NCPAP and 111 BiPAP. Invasive ventilation was needed in 18.3% in the CPAP group and 14.4% in the BiPAP group. This difference was not statistically significant. However, when stratifying the groups regarding gestational age (GA), we found a tendency favouring BiPAP in subgroup of 30 to 32+6 weeks. There was no difference regarding the secondary outcomes, except for an increase in NEC in the CPAP group. Multivariate analysis demonstrated a significant association between absence of premature rupture of membranes and the need of invasive ventilation within the first 120 hours of life, independently on the assigned mode of non invasive ventilation. Conclusion:BiPAP and CPAP are both effective and safe as a primary mode of ventilation in preterms between 27 and 32+6 weeks without important complications. In a subgroup of 30 to 32+6 weeks of gestation a better outcome using BiPAP was observed.

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“…1, 2 The results of randomized controlled trials (RCTs), considered both individually [3][4][5] and collectively, 6,7 suggest that initiation of nasal continuous positive airway pressure (CPAP) is at least as good, if not better than early intubation and exogenous surfactant therapy. These findings have recently led to an American Academy of Pediatrics recommendation that application of CPAP at the outset should be considered as a worthy alternative to intubation, including at the lower extremes of gestation.…”

mentioning

confidence: 99%

Incidence and Outcome of CPAP Failure in Preterm Infants

et al. 2016

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Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

Cited by 259 publications

References 80 publications

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Nasal Bilevel Versus Continuous Positive Airway Pressure in Preterm Infants: A Randomized Controlled Trial

Incidence and Outcome of CPAP Failure in Preterm Infants

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