PT - JOURNAL ARTICLE AU - Charles A Friedman AU - Robert C Menchaca AU - Mary C Baker AU - Clarissa K Rivas AU - Raymond N Laberge AU - Enrique H Rios AU - Syed H Haider AU - Edgar J Romero AU - Elizabeth B Eason AU - J Kennard Fraley AU - Mesfin Woldesenbet TI - Bubble Nasal CPAP, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Newborns: Efficacy and Safety Considerations AID - 10.4187/respcare.01998 DP - 2013 Jul 01 TA - Respiratory Care PG - 1134--1142 VI - 58 IP - 7 4099 - http://rc.rcjournal.com/content/58/7/1134.short 4100 - http://rc.rcjournal.com/content/58/7/1134.full AB - BACKGROUND: Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage. OBJECTIVE: To determine if introduction of bubble nasal CPAP (bnCPAP), early surfactant treatment, and rapid extubation (combined bnCPAP strategy) in our community-based neonatal ICU reduced bronchopulmonary dysplasia (BPD). METHODS: This was a 7-year retrospective, single-institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model. RESULTS: The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4% (P = .02), reaching a minimum in the last post-bnCPAP year of 22.1% (P = .02). When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD (P = .003, odds ratio 0.43, 95% CI 0.25–0.75). Decreases occurred in mechanical ventilation and the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely-low-birth-weight newborns, improved respiratory outcomes in the post-bnCPAP years, as compared to outcomes in the pre-bnCPAP years, included an increase in the percentage alive and off mechanical ventilation at 1 week postnatal age (P < .001), a more rapid extubation rate (P < .03), a decrease in the median days on mechanical ventilation (P = .002), and a decrease in the percentage with BPD plus died (P = .01). Post-bnCPAP extremely-low-birth-weight babies had a statistically significant decrease in retinopathy of prematurity, an increase in low-grade intraventricular hemorrhage, and a decrease in ductal ligations. CONCLUSIONS: A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.