Prophylactic nasal continuous positive airways pressure in newborns of 28-31 weeks gestation: multicentre randomised controlled clinical trial

Sandri, Fabrizio; Ancora, Gina; Lanzoni, Alberto; Tagliabue, Paolo; Colnaghi, Mariarosa; Ventura, Maria Luisa; Rinaldi, Matteo; Mondello, Isabella; Gancia, Paolo; Gp, Salvioli; Orzalesi, M; Mosca, Fabio

doi:10.1136/adc.2003.037010

Cited by 100 publications

(50 citation statements)

References 26 publications

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“…1,2,[11][12][13][14][15][16][17] Specific interventions included strategies to avoid hypothermia; establishment of lung volume in the least-invasive manner; and supporting teamwork with checklists, briefings, and debriefings.…”

mentioning

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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confidence: 99%

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

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

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“…38 Success with CPAP depended on the experience of the staff and gestational age of infants, especially infants <29 weeks. 38 Sandri et al 39 in a multicenter trial demonstrated no difference in BPD in infants between 28 and 31 weeks gestational age treated with prophylactic or rescue NCPAP. A major limitation of NCPAP is the need for intubation due to frequent apnea, bradycardia or desaturations in preterm infants.…”

Section: Noninvasive Ventilation Strategiesmentioning

confidence: 97%

Lung protective ventilatory strategies in very low birth weight infants

Ramanathan

Sardesai

2008

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory diagnosis in preterm infants. Surfactant therapy and mechanical ventilation using conventional or high-frequency ventilation have been the standard of care in the management of RDS. Bronchopulmonary dysplasia (BPD) continues to remain as a major morbidity in very low birth weight infants despite these treatments. There is no significant difference in pulmonary outcome when an optimal lung volume strategy is used with conventional or high-frequency ventilation. Lung injury is directly related to the duration of invasive ventilation via the endotracheal tube. Studies using noninvasive ventilation, such as nasal continuous positive airway pressure and noninvasive positive pressure ventilation, have shown to decrease postextubation failures as well as a trend toward reduced risk of BPD. Lung protective ventilatory strategy may involve noninvasive ventilation as a primary therapy or following surfactant administration in very preterm infants with RDS. Initial steps in the management of preterm infants may also include sustained inflation to establish functional residual capacity, followed by noninvasive ventilation to minimize lung injury and subsequent development of BPD.

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“…Success depended on the gestational age of the infants and experience of care providers over time. While evaluating the benefits of prophylactic NCPAP in more mature preterm infants born between 28 and 31 weeks gestation in a multicenter randomized clinical trial, Sandri et al 23 showed no benefits of prophylactic NCPAP over rescue NCPAP initiated when the oxygen requirements increased to greater than 40%. Recently, use of portable devices, such as Neopuff Infant Resuscitator (Fisher & Paykel Healthcare Corporation Limited, Irvine, CA, USA) to deliver consistent positive end-expiratory pressure in the delivery room and during transport from the delivery room, is gaining popularity.…”

Section: Cpap Generatorsmentioning

confidence: 99%

Early surfactant therapy and noninvasive ventilation

Ramanathan

2007

J Perinatol

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Respiratory distress syndrome (RDS) is the most common respiratory morbidity in very low birth weight (VLBW) preterm infants. Surfactant therapy is the standard care for infants with RDS. Natural surfactants appear to be better than synthetic surfactants for RDS treatment. Lung injury remains an important cause of morbidity among VLBW infants despite current treatments. Barotrauma, volutrauma or oxygen-induced lung inflammation contributes to the development of bronchopulmonary dysplasia (BPD). Observational studies using noninvasive ventilation, such as, nasal continuous positive pressure (NCPAP) show a decrease in BPD when used to avoid intubation or minimize the duration of mechanical ventilation via endotracheal tube. Recently, nasal intermittent positive pressure ventilation (NIPPV) has been shown to decrease post-extubation failures significantly compared to NCPAP and has demonstrated a trend toward reduced risk of BPD. The administration of early surfactant followed by noninvasive ventilation has also been shown to improve pulmonary outcomes.

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Prophylactic nasal continuous positive airways pressure in newborns of 28-31 weeks gestation: multicentre randomised controlled clinical trial

Cited by 100 publications

References 26 publications

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

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

Lung protective ventilatory strategies in very low birth weight infants

Early surfactant therapy and noninvasive ventilation

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