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

Respir Care. 2013 Jul;58(7):1134-42. doi: 10.4187/respcare.01998.

Abstract

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 of22.1% (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.

MeSH terms

  • Airway Extubation* / methods
  • Airway Extubation* / statistics & numerical data
  • Bronchopulmonary Dysplasia* / epidemiology
  • Bronchopulmonary Dysplasia* / etiology
  • Bronchopulmonary Dysplasia* / prevention & control
  • Continuous Positive Airway Pressure* / methods
  • Continuous Positive Airway Pressure* / statistics & numerical data
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Logistic Models
  • Male
  • Outcome and Process Assessment, Health Care
  • Pulmonary Surfactants / therapeutic use*
  • Respiratory Distress Syndrome, Newborn* / complications
  • Respiratory Distress Syndrome, Newborn* / epidemiology
  • Respiratory Distress Syndrome, Newborn* / therapy
  • Retrospective Studies
  • Survival Analysis
  • Texas / epidemiology
  • Time Factors
  • Treatment Outcome

Substances

  • Pulmonary Surfactants