Variables Associated with the Early Failure of Nasal CPAP in Very Low Birth Weight Infants

Ammari, Amer; Suri, Mandhir; Milisavljevic, Vladana; Sahni, Rakesh; Bateman, David A.; Sanocka, Ulana; Ruzal-Shapiro, Carrie; Wung, Jen-Tien; Polin, Richard A.

doi:10.1053/j.nainr.2006.03.002

Cited by 51 publications

(73 citation statements)

References 24 publications

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“…This was similar to the findings in our study. In a retrospective study by Ammari et al 14 , none of the babies with gestation >30 weeks failed CPAP.…”

Section: Discussionmentioning

confidence: 94%

A descriptive study on the use of bubble CPAP in a level 2 neonatal intensive care unit in Bangalore, India

Parasuramappa

Belavadi

2017

Sri Lanka J Child Health

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Background: Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm infants. An effective way to reduce the incidence of chronic lung injury is to use continuous positive airway pressure (CPAP) and avoid mechanical ventilation. Objective:To assess the effectiveness of bubble CPAP (BCPAP) on immediate outcome of preterm infants with mild to moderate RDS in a level 2 neonatal intensive care unit (NICU) in Bangalore, India.Method: A prospective analytical study was carried out on preterm neonates of gestational age 28 to 36 weeks with mild to moderate RDS admitted to a level 2 NICU in Bangalore, India, from November 2011 to May 2013. Downe score (DS) was used to assess the severity of RDS. Effectiveness of CPAP was judged using DS and fraction of inspired oxygen (FiO2) requirement.Results: BCPAP was effective in 91% of the studied babies. At the start of CPAP 11%, 48% and 41% of babies had DS of 4, 5 and 6 respectively. At 6 hours of CPAP therapy, 56% of the babies had a score of less than 4. At 12 hours of CPAP therapy 89% of babies had a score of 4 or less, only 3% and 8% of the babies having DS of 5 and 6 respectively. Nine percent of the babies persisted in having a FiO2 requirement of 50% or more at 6 and 12 hours of CPAP therapy. BackgroundRespiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm infants 1 . Diagnosis of RDS is based on a chest x-ray consistent with RDS, and response to surfactant therapy 2 . Mechanical ventilation is invasive and can injure the airway and lung parenchyma. An effective way to reduce the incidence of chronic lung injury is the use of continuous positive airway pressure (CPAP) and avoidance of mechanical ventilation 1,3 . Bubble CPAP (BCPAP) prevents alveolar collapse, ensures gas exchange throughout the respiratory cycle and allows lung inflation to be maintained. It can be effectively given through the silastic nasal tubes or nasal prongs which eliminate the need for the endotracheal intubation 4 . CPAP preserves spontaneous breathing, does not require endotracheal intubation and may result in less lung injury than mechanical ventilation 5 . However, not all preterm infants with RDS respond to BCPAP and not all preterm infants with RDS are candidates for initial treatment with CPAP 4,6 .

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“…This was similar to the findings in our study. In a retrospective study by Ammari et al 14 , none of the babies with gestation >30 weeks failed CPAP.…”

Section: Discussionmentioning

confidence: 94%

A descriptive study on the use of bubble CPAP in a level 2 neonatal intensive care unit in Bangalore, India

Parasuramappa

Belavadi

2017

Sri Lanka J Child Health

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“…12 Because infants who require mechanical ventilation for management of RDS have improved outcomes if they receive early surfactant, 22,23 we decided to intubate and provide surfactant in the delivery room for all infants born before 26 weeks' gestation but to start CPAP in the delivery room for breathing but distressed infants born at Ն26 weeks' gestation. …”

Section: Provision Of Bcpap In the Delivery Roommentioning

confidence: 99%

“…3,4 On the other hand, early treatment with CPAP can preserve endogenous surfactant and reduce the need for mechanical ventilation and surfactant administration [5][6][7][8][9][10][11] but may be insufficient support for infants born before 26 weeks' gestation. 12 Although there is a growing body of evidence to guide decision making, there is not yet consensus on the best treatment approach for RDS.…”

mentioning

confidence: 99%

Impact of Implementing 5 Potentially Better Respiratory Practices on Neonatal Outcomes and Costs

et al. 2011

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OBJECTIVE:We implemented 5 potentially better practices to limit mechanical ventilation (MV), supplemental oxygen, and bronchopulmonary dysplasia in newborn infants born before 33 weeks' gestation. METHODS:The methods used in this study included (1) exclusive use of bubble continuous positive airway pressure (bCPAP), (2) provision of bCPAP in the delivery room, (3) strict intubation criteria, (4) strict extubation criteria, and (5) prolonged CPAP to avoid supplemental oxygen. We excluded outborn infants and those with major anomalies and obstetric complications from analysis. RESULTS:Demographics were similar in 61 infants born before and 60 born after implementation. For infants born at 26 to 32 6 ⁄ 7 weeks' gestation, intubation (first 72 hours) decreased from 52% to 11% (P Ͻ .0001) and surfactant use decreased from 48% to 14% (P ϭ .0001). In all infants, the mean Ϯ SD fraction of inspired oxygen requirement (first 24 hours) decreased from 0.27 Ϯ 0.08 to 0.24 Ϯ 0.05 (P ϭ .0005), days of oxygen decreased from 23.5 Ϯ 44.5 to 9.3 Ϯ 22.0 (P ϭ .04), and days of MV decreased from 8.8 Ϯ 27.8 to 2.2 Ϯ 6.2 (P ϭ .005). Hypotension decreased from 33% to 15% (P ϭ .03). The percentage of infants with bronchopulmonary dysplasia was 17% before and 8% after (P ϭ .27). Nurse staffing ratios remained unchanged. CONCLUSIONS:Implementation of these potentially better practices reduced the need for MV, surfactant, and supplemental oxygen as well as reduced hypotension among infants born before 33 weeks' gestation without adverse consequences. The costs for equipment and surfactant were lower. Pediatrics 2011;128:e218-e226 All the authors made substantive intellectual contributions to this report. Dr Levesque contributed to the conception and design of the study, implementation, data collection, analysis, and interpretation, drafted the article, and approved the version submitted; Dr Kalish contributed to the data analysis and interpretation and critical revising of the article for important intellectual content and approved the final version submitted; and Ms LaPierre, Ms Welch, and Ms Porter participated in the conception and design, implementation, data collection and interpretation, and revising of the article and approved the version submitted.www.pediatrics.org/cgi

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“…Recent evidence suggest that CPAP reduces the adverse events rate, as post-extubation atelectasis, apnea episodes, respiratory acidosis and tracheal reintubation requirements. (28) Bradycardia, oxygen saturation drop, apnea, cyanosis, bronchoaspiration and respiratory distress were the main reintubation causes in both groups. Several studies confirm our results, indicating among the main failure causes apnea and increased respiratory load.…”

Section: Discussionmentioning

confidence: 87%

Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

Andrade¹,

Melo²,

Morais³

et al. 2010

Rev. bras. ter. intensiva

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Variables Associated with the Early Failure of Nasal CPAP in Very Low Birth Weight Infants

Cited by 51 publications

References 24 publications

A descriptive study on the use of bubble CPAP in a level 2 neonatal intensive care unit in Bangalore, India

A descriptive study on the use of bubble CPAP in a level 2 neonatal intensive care unit in Bangalore, India

Impact of Implementing 5 Potentially Better Respiratory Practices on Neonatal Outcomes and Costs

Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

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