GEIDIS is a national based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1,780 patients diagnosed with BPD. Of the total sample, 98.6% were premature (less than 37 weeks) and 89,4% less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 890 g (740-1,090 g). 52.3% (n=931) were classi ed as mild (type 1), 25.1% (n=447) were moderate (type 2), and 22.6% (n=402) severe BPD (type 3).Most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO 2 of > 0.30 in the delivery room, two or more doses of surfactant administration, nosocomial pneumonia, and the length of exposure to MV.Conclusions: In this national based research-net registry of BPD patients the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO 2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO 2 < .30.

Background Noninvasive ventilation is being increasingly used on preterm infants to reduce ventilator lung injury and bronchopulmonary dysplasia. The aim of this study was to evaluate the effectiveness of synchronized nasal intermittent positive pressure ventilation (SNIPPV) to prevent intubation in premature infants. Methods Prospective observational study of SNIPPV use on preterm infants of less than 32 weeks' gestation. All patients were managed using a prospective protocol intended to reduce invasive mechanical ventilation (iMV) use. Previous respiratory status, as well as respiratory outcomes and possible secondary side effects were analyzed. Results SNIPPV was used on 78 patients: electively to support extubation on 25 ventilator-dependent patients and as a rescue therapy after nasal continuous positive airway pressure failure on 53 patients. For 92% of patients in the elective group and 66% in the rescue group, iMV was avoided over the following 72 hours. No adverse effects were detected, and all patients were in a stable condition even if intubation was eventually needed. Conclusions The application of SNIPPV in place of or to remove mechanical ventilation avoids intubation in 74.4% of preterm infants with respiratory failure. No adverse effects were detected.

GEIDIS is a national based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1,780 patients diagnosed with BPD. Of the total sample, 98.6% were premature (less than 37 weeks) and 89,4% less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8–28.5) and median birth weight 890 g (740–1,090 g). 52.3% (n=931) were classified as mild (type 1), 25.1% (n=447) were moderate (type 2), and 22.6% (n=402) severe BPD (type 3). Most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, two or more doses of surfactant administration, nosocomial pneumonia, and the length of exposure to MV. Conclusions: In this national based research-net registry of BPD patients the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks’ postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30.

Objective Analysis of longitudinal data can provide neonatologists with tools that can help predict clinical deterioration and improve outcomes. The aim of this study is to analyze continuous monitoring data in newborns, using vital signs to develop predictive models for intensive care admission and time to discharge. Study Design We conducted a retrospective cohort study, including term and preterm newborns with respiratory distress patients admitted to the neonatal ward. Clinical and epidemiological data, as well as mean heart rate and saturation, at every minute for the first 12 hours of admission were collected. Multivariate mixed, survival and joint models were developed. Results A total of 56,377 heart rate and 56,412 oxygen saturation data were analyzed from 80 admitted patients. Of them, 73 were discharged home and 7 required transfer to the intensive care unit (ICU). Longitudinal evolution of heart rate (p < 0.01) and oxygen saturation (p = 0.01) were associated with time to discharge, as well as birth weight (p < 0.01) and type of delivery (p < 0.01). Longitudinal heart rate evolution (p < 0.01) and fraction of inspired oxygen at admission at the ward (p < 0.01) predicted neonatal ICU (NICU) admission. Conclusion Longitudinal evolution of heart rate can help predict time to transfer to intensive care, and both heart rate and oxygen saturation can help predict time to discharge. Analysis of continuous monitoring data in patients admitted to neonatal wards provides useful tools to stratify risks and helps in taking medical decisions. Key Points