Outcomes for infants weighing less than 1000 grams cared for with a nasal continuous positive airway pressure‐based strategy

Abstract

Improved respiratory outcomes for infants weighing less than 1000 g were evident at Middlemore Hospital. This was attributed to the use of a nasal CPAP-based respiratory support system.

Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

“…Finally, a study from New Zealand described a lower rate of CLD (at 36 weeks' PMA) with a policy of preferential water seal bubble NCPAP delivery in ELBW infants at a single center, when compared to composite data from 28 other centers (19 vs 45%). 24 The rate of CLD in the study is considerably lower than ours, although the incidence of CLD or death is similar (40%).…”

“…We also observed a trend to a decrease in late-onset infections in the Early NCPAP group, which has been described in other reports of preferential NCPAP use in the ELBW population. 21,24 This may be due to the lack of endotracheal tube as a site of colonization and a portal of entry for infection, or other differences in care that occurred as a result of the practice change but were not evaluated in our study, as duration of mechanical ventilation is only one factor associated with late-onset sepsis in preterm infants. 29 We have used historic controls in our study as a comparison group, as have other studies of preferential early NCPAP in ELBW infants published to date.…”

“…Other reports have described decreases in severe ICH 14 and increases in the incidence of NEC and PDA in association with institution of preferential early NCPAP. 20,24 We did not demonstrate these differences and only a controlled study would be able to allay concerns regarding these findings, which may be due to chance. We also observed a trend to a decrease in late-onset infections in the Early NCPAP group, which has been described in other reports of preferential NCPAP use in the ELBW population.…”

Factors that influence mesenteric artery blood flow velocity in newborn preterm infants

“…CPAP versus intubation/mechanical ventilation is associated with decreased incidences of bronchopulmonary dysplasia and sepsis, and with a trend toward decreased rates of retinopathy of prematurity and intraventricular hemorrhage. [19][20][21] CPAP, however, may contribute to the development of benign gaseous bowel distension in neonates (CPAP belly syndrome), 22 and it may be associated with an increased rate of necrotizing enterocolitis. 19,20 It is not clear if the attenuated SMA BFV was owing to CPAP-related decreases in cardiac output, nor if bowel-related concerns with CPAP relate to our finding of attenuated increases in postnatal SMA BFV in infants on CPAP.…”

“…[19][20][21] CPAP, however, may contribute to the development of benign gaseous bowel distension in neonates (CPAP belly syndrome), 22 and it may be associated with an increased rate of necrotizing enterocolitis. 19,20 It is not clear if the attenuated SMA BFV was owing to CPAP-related decreases in cardiac output, nor if bowel-related concerns with CPAP relate to our finding of attenuated increases in postnatal SMA BFV in infants on CPAP. However, other investigators have reported that attenuated increases in postnatal SMA BFV are associated with intestinal dysmotility, 2 and with feeding intolerance.…”