Using Clinical Guidelines for Early Continuous Positive Airway Pressure to Decrease the Incidence of Chronic Lung Disease in Premature Infants

Abstract

Background: Infants born prematurely are at risk of developing chronic lung disease (CLD) due to their immature lungs and the use of invasive mechanical ventilation (MV). At Aurora Sinai Medical Center (ASMC), the rate of very low birth weight premature infants (<1,500 g) on oxygen at 36 weeks gestational age (GA) is above average when compared to the Vermont Oxford Network national database. Because CPAP at delivery has been recognized as an effective treatment to reduce intubation and invasive MV methods, we implemented a clinical guideline to provide a standard practice to reduce invasive MV for neonatal patients (26-32 weeks old) by using CPAP for the first 72 h of life.

Methods: Retrospective chart review of all infants born between GA of 26 to 32 weeks and admitted to ASMC’s Neonatal Intensive Care Unit in 2018 and 2019. Data from 02/2018 to 12/2018 was compared to data after clinical guideline implementation, 02/2019 to 12/2019. Effectiveness is determined as non-diagnosis of CLD. Noninvasive ventilation techniques (NIVTs) includes noninvasive ventilation, heated wire nasal cannula, and CPAP. Basic descriptive statistics were used to describe the population.

Results: There were 46 patients enrolled in 2018 and 50 patients enrolled in 2019. GA (M=29 weeks) was similar for 2018 and 2019 groups. Initial respiratory support at delivery showed that for infants <1,500 g NIVTs was used similarly in 2018 (47%) vs 2019 (40%). By 24 h of life, these NIVTs increased in infants <1,500 g to 85% in 2019 when compared to 66% in 2018. Similarly, NIVTs showed a clinical increase at 48 and 72 h of life in 2019 vs 2018 for infants <1,500 g. However, for infants ≥1,500 g for 24, 48, and 72 h of life NIVTs remained unchanged. Intubation at birth for infants <1,500 g occurred 53% in 2018 compared to 55% in 2019, and the trend was similar for infants ≥1,500 g in 2018 (36%) vs 2019 (40%). In terms of CLD diagnosis, there was no difference for infants born <1,500 g in 2018 (34%) compared to 2019 (35%). The same was seen in infants born ≥1,500 g in 2018 (14%) compared to 2019 (10%).

Conclusions: Although the new guidelines did not reduce the rate of CLD, the team was able to decrease the use of invasive MV in the first 72 h of life. The need to further hardwire best practices in this area will lead to a reduction in CLD and other related complications from invasive MV.