Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

Jegatheesan, Priya; Keller, Reinhold; Hawgood, Sam

doi:10.1038/sj.jp.7211454

Cited by 15 publications

(10 citation statements)

References 34 publications

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“…There were no statistically significant differences in ventilator-days, deaths, infections, IVH or LOS. There is debate whether early NCPAP decreases the risk of BPD in infants <30 weeks GA. [4][5][6][7][8] Our data did not show a difference in BPD rates between the NCPAP and HHFNC groups. Although there was a lower rate of BPD in infants who received HHFNC as first intention versus NCPAP, especially in the 26 to 29 6/7 week GA group, the numbers were small and the power inadequate.…”

Section: Discussioncontrasting

confidence: 66%

“…2,3 Given this, there is now a concerted effort in many practices to avoid the use of prolonged invasive ventilatory support when treating acute respiratory distress in premature infants with early application of nasal continuous positive airway pressure (NCPAP) either immediately after birth or following a brief period of intubation, mechanical ventilation and dosing with surfactant. [4][5][6][7][8] An alternative to the use of NCPAP as a non-invasive modality to support respiratory distress in premature infants has been the recent introduction of humidified high flow nasal cannula (HHFNC) devices in many units. Although its use has been widely adopted, there have been only a few published abstracts describing its use in the neonatal population and no clinical trials using flows >2 l/min.…”

Section: Introductionmentioning

confidence: 99%

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High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study

Pierce²,

et al. 2007

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Objective: Our objective is to assess the frequency of usage, safety and clinical utility of humidified high flow nasal cannula (HHFNC) in two tertiary care hospitals and compare outcomes to a historical control group of premature infants who received nasal continuous positive airway pressure (NCPAP). Study design:The first part of the study describes the increased HHFNC usage in two tertiary neonatal intensive care units. The second part compares outcomes of infants, born at less than 30 weeks gestation, who received either NCPAP or HHFNC as an early respiratory support mode.

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Section: Discussioncontrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study

Pierce²,

et al. 2007

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“…NTDs are an important cause of mortality and morbidity globally with a conservative estimated incidence of >300 000 new cases a year 2 resulting in an estimated 41 000 deaths and 2.3 million disability-adjusted life years (DALYS) 3 . They thus comprise about one-tenth of the burden of all congenital conditions and constitute the third largest congenital burden after congenital heart disease and Down’s syndrome 3 …”

Section: Introductionmentioning

confidence: 99%

Folic acid to reduce neonatal mortality from neural tube disorders

Blencowe

Cousens

Modell

et al. 2010

International Journal of Epidemiology

391

264

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Background Neural tube defects (NTDs) remain an important, preventable cause of mortality and morbidity. High-income countries have reported large reductions in NTDs associated with folic acid supplementation or fortification. The burden of NTDs in low-income countries and the effectiveness of folic acid fortification/supplementation are unclear.Objective To review the evidence for, and estimate the effect of, folic acid fortification/supplementation on neonatal mortality due to NTDs, especially in low-income countries.Methods We conducted systematic reviews, abstracted data meeting inclusion criteria and evaluated evidence quality using adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Where appropriate, meta-analyses were performed.Results Meta-analysis of three randomized controlled trials (RCTs) of folic acid supplementation for women with a previous pregnancy with NTD indicates a 70% [95% confidence interval (CI): 35–86] reduction in recurrence (secondary prevention). For NTD primary prevention through folic acid supplementation, combining one RCT with three cohort studies which adjusted for confounding, suggested a reduction of 62% (95% CI: 49–71). A meta-analysis of eight population-based observational studies examining folic acid food fortification gave an estimated reduction in NTD incidence of 46% (95% CI: 37–54). In low-income countries an estimated 29% of neonatal deaths related to visible congenital abnormalities are attributed to NTD. Assuming that fortification reduces the incidence of NTDs, but does not alter severity or case-fatality rates, we estimate that folic acid fortification could prevent 13% of neonatal deaths currently attributed to congenital abnormalities in low-income countries.Discussion Scale-up of periconceptional supplementation programmes is challenging. Our final effect estimate was therefore based on folic acid fortification data. If folic acid food fortification achieved 100% population coverage the number of NTDs in low-income countries could be approximately halved.Conclusion The evidence supports both folic acid supplementation and fortification as effective in reducing neonatal mortality from NTDs.

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“…These outcomes are comparable with those reported by others. [10][11][12][13] It is reassuring that our outcomes in routine use across nearly all the neonatal ICU's in Poland are comparable with that seen in more controlled situations.…”

Section: Discussionmentioning

confidence: 73%

Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure

et al. 2009

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Objective: Although interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure.Study Design: In all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression.Result: Intubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO 2 / FiO 2 <150 or pH< 7.25) and Bad Outcome (FiO 2 , low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria. Conclusion:We hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.

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Early variable-flow nasal continuous positive airway pressure in infants ⩽1000 grams at birth

Cited by 15 publications

References 34 publications

High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study

High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study

Folic acid to reduce neonatal mortality from neural tube disorders

Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure

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