Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

Permatahati, Winda Intan; Setyati, Amalia; Haksari, Ekawaty Lutfia

doi:10.1177/2333794x211007464

Cited by 7 publications

(10 citation statements)

References 15 publications

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“…Results of our studied preterms, adds to the controversy about APGAR score. APGAR score at 1, 5 and 10 minutes, need for resuscitation, mode of delivery and used anesthesia during delivery had non-significant correlations with the CPAP success or failure contrary to other studies (28,29). In the current study, the mean GA, mean birth weight, were lower in the CPAP failure group, but all did not show a statistical significance among both groups contrary to others (30,31).…”

Section: Discussioncontrasting

confidence: 92%

Clinical Predictors for Outcome of Continuous Positive Airway Pressure in Respiratory Distress Syndrome in Preterms: Single Center Study

Sabry

Saber

Khairy

et al. 2022

Pediatric Sciences Journal

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Background: Applying mechanical ventilation (MV) to premature lungs carries many risks, up to lung injury and bronchopulmonary dysplasia. Stabilization with continuous positive airway pressure (CPAP) avoids intubation and invasiveness. Aim of work:To evaluate the predictors of outcome of nasal CPAP on preterms with respiratory distress syndrome (RDS). Material and Methods: This prospective observational study included all preterms with RDS that necessitated CPAP introduction (according to the European Consensus Guidelines on the Management of RDS), who were admitted to the Neonatal Intensive Care Unit (NICU) of Department of Pediatrics, Cairo University Hospitals, from February to July 2019. CPAP was initiated in the first 2 hours of life. Respiratory compromise was assessed using Silverman score. Hematological scoring system (HSS) was studied as a predictor of outcome. Those who did not need subsequent intubation were labeled CPAP success group and were compared to the group where CPAP failed. Results: Over 6-months, 508 preterm with gestational age (GA) 27-33 weeks with RDS were admitted to our NICU, of them 61 (mean GA± SD of 32.08 ± 1.98 weeks) were included in the study. Of them 35 (57.4%) were males and 26 (42.6 %) females. CPAP was successful in 37 (60.7%) and Silverman score improved 2 hours after CPAP. Their initial median (IQR) of Silverman score was 5 (range 3-6) and improved to 1 (range 1-2) 2 hours after CPAP, while in the failure group, it was 6 (range 5-7) initially and worsened to 8 (range 7.5-9) (p=0.026). Antenatal steroids administration was highly protective (p= 0.000) but not GA p=0.086) or gender (p=0.521). Initial severe RDS in chest X-ray at birth was present in 1 (2.7 %) preterm in the CPAP success group and 10 (41.7 %) in the failure group (p=0.000). The systolic blood pressure ≤ 66, HSS, chest X-ray before CPAP, non-improvement of chest X-ray after CPAP and apnea were the important predictors for CPAP failure (p= 0.023), (p= 0.090), (p= 0.025), (p= 0.011) and (p= 0.049) respectively. Conclusion: Trials of CPAP for preterms with severe RDS with hemodynamic stability are effective in obviating the need for more invasive MV. Factors including hypercarbia, apnea, poor respiratory efforts, systemic hypotension, higher Silverman score and HSS ≥5 were the most significant associations of failed CPAP.

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Section: Discussioncontrasting

confidence: 92%

Clinical Predictors for Outcome of Continuous Positive Airway Pressure in Respiratory Distress Syndrome in Preterms: Single Center Study

Sabry

Saber

Khairy

et al. 2022

Pediatric Sciences Journal

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“…Initiation of FiO 2 requirement ≥30% proved to be a significant predictor factor of nasal CPAP failure. 30 It exposes newborn infants to oxygen levels that are too high and to hyperoxic states. Hyperoxia has deleterious effects on the neonate's brain through mechanisms of inflammation, apoptosis, and oxidative stress.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Noninvasive Ventilation Failure Among Neonates with Respiratory Distress Admitted to the Intensive Care Unit in Addis Ababa, Ethiopia: An Unmatched Case-Control Study Design

Yimer

Alemu

Demissie

2023

Journal of Neonatology

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Background Respiratory distress contributes significantly to mortality and morbidity in infants. The incidence of noninvasive ventilation failure is remarkably high. There is limited data available regarding noninvasive ventilation failure in Ethiopia. Therefore, this study aimed to identify determinants of noninvasive ventilation failure among neonates with respiratory distress admitted to the intensive care unit in Addis Ababa, Ethiopia in 2022. This study was conducted from November 11, 2021, to January 30, 2022. A total of 237 charts (79 cases and 158 controls) were selected by a simple random sampling technique. Cases were defined as neonates who failed with noninvasive ventilation support while controls were successfully managed with noninvasive ventilation support. The data were abstracted from the facility-based data abstraction form. The data were cleaned, entered into Epidata version 4.4, and exported to SPSS version 25.0 software for analysis. Both binary and multiple logistic regression analyses were used to identify the determinants of noninvasive ventilation failure in neonates with respiratory distress with an adjusted odds ratio (AOR) with a 95% confidence level at P value < .05 used to declare determinants of a noninvasive ventilation failure. The mean birth weights of the neonates were 2.87 ± 0.85 SD kilograms and the mean gestational age was 35.02±2.66 SD. The current study determined that the incidence of noninvasive ventilation failure among neonates with respiratory distress was 20/100 per person-year in 2021. This study identified that determinants of noninvasive ventilation failure among neonates with respiratory distress were: very preterm neonates (AOR = 2.99 [95%CI: 1.11–8.12]); comorbid illness in mothers (AOR = 3.13 [95%CI: 1.55–6.33]), initiation of noninvasive ventilation at admission to the newborn intensive care unit (AOR = 2.63 [95%CI: 1.24–5.59]); oxygen saturation (SpO2) <85 and 85–93 SpO2 (AOR = 3.11 [95%CI: 1.32–7.32]) and (AOR = 2.75 [95%CI: 1.17–6.44]), Apgar score at 5 min <7(AOR = 3.19 [95%CI: 1.48–6.89]), and noninvasive ventilation through a home-made CPAP (AOR = 4.09 [95%CI: 1.82–9.20]), respectively. Conclusion and Recommendation The incidence rate of noninvasive ventilation failure among neonates is very high with identified determinants of noninvasive ventilation failures being comorbidity illness of the mother, Apgar score, Oxygen saturation at admission in %, ventilator modality of homemade CPAP, and initiation time of noninvasive ventilation. Therefore, policymakers and health planners would be better emphatically considering these identified determinants during neonatal training and guideline development for better neonatal noninvasive ventilation outcomes.

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“…When their research team compared the Downes' score to the Silverman Andersen score in this Indian NICU, the Silverman Andersen score had lower inter‐rater reliability, and participants found the Downes' score to be comparatively easier to use and assessments were quicker to complete 9 . The use of the Downes' score or a modified Downes' score has also been implemented and its use published in multiple other LMIC settings, including China, 10 Indonesia, 11 and Nigeria 12 …”

Section: Discussionmentioning

confidence: 99%

High inter‐rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

Ehret,

Demtse Gebremedhin,

Hadgu Berhe

et al. 2023

Acta Paediatrica

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AimTo assess the inter‐rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score‐based treatment for preterm infants with respiratory distress.MethodsWe included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4.ResultsOf the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score‐based treatment.ConclusionIncorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near‐perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score‐based treatment recommendations. These results highlight an opportunity for task‐shifting assessments and empowering nurses.

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Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

Cited by 7 publications

References 15 publications

Clinical Predictors for Outcome of Continuous Positive Airway Pressure in Respiratory Distress Syndrome in Preterms: Single Center Study

Clinical Predictors for Outcome of Continuous Positive Airway Pressure in Respiratory Distress Syndrome in Preterms: Single Center Study

Determinants of Noninvasive Ventilation Failure Among Neonates with Respiratory Distress Admitted to the Intensive Care Unit in Addis Ababa, Ethiopia: An Unmatched Case-Control Study Design

High inter‐rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

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