The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Delivery Room Nasal Continuous Positive Airway Pressure as an Alternative to Intubation in 26 – 30 Week Neonates.

Patricia Meyers RRT, JL Nold MD, JM Coleman MD, N Kilau RRT, G Fersk RN, MC Mammel MD. Children’s Hospitals & Clinics, St. Paul MN.

Background: Beginning in March 2002, we targeted all patients 26 –30 wks estimated gestational age (EGA) with spontaneous respiratory effort and no known congenital anomlies for delivery room (DR) NCPAP. Can NCPAP initiated in the DR be effectively used as an alternative to intubation in 26 – 30 wk EGA infants?

Methods
: The decision to initiate NCPAP was made in the DR. NCPAP was continued until patients were ≥ 1000g or ≥ 28 wks adjusted age. We report prospective observational data over 18 months from a group of neonates treated with DR NCPAP, and retro-spective comparisons for similar babies from the previous 2 years. We compared: birth weight (BW), gestational age (GA), days of NCPAP, NCPAP failure requiring intubation, days of mechanical ventilation (MV), O2 need at 36 weeks, days to regain BW, weight at discharge (D/C), adjusted age at D/C, home O2, and incidence of pneumo-thorax / PIE, NEC, ROP, and IVH. We then compared selected variables from the observational group (period 1) to 26 – 30 week babies born from 3/1/02 – 8/28/03 (period 2).

Results:
Data are mean (±SD).

3/02-12/03 n BW (g) CPAP MV (d) BW (d) O2 @ 36 wk Home O2
DR NCPAP 26 1066 ±228 11.0 ±8.5 3.0** ±7.0 8.9 ±4.2 35% 12%
DR Intub. 20 915 ±230 10.3 ±1.3 14.5 ±18.1 8.9 ±4.7 53% 42%
No DR Tx 12 1175 ±192 7.6 ±9.8 1.8** ±2.5 10.3 ±4.6 25% 17%
Per. 1 vs 2 n BW (g) DR Int. % Surv. DC age O2 @ 36 wk Home O2
Period 1 1/00-12/01 120 1103 ±243 86% 93% 38.4 ±5.3 44% 28%
Period 2 3/02-8/03 58 1041 ±237 35%* 98% 37.1# ±2.4 39% 23%

p = ≤ 0.05 DR CPAP vs no Tx , p = ≤ 0.01 Intub vs no Tx , p = < 0.06 *, p = ≤ 0.01 DR CPAP & no Tx vs DR Intub**, p = < 0.0001#

Conclusion: These observational data suggest that NCPAP can be used in this group of patients safely with the potential for reduction of mortality, lung injury and chronic lung disease, and earlier healthy discharge. Large randomized trials are needed to define potential benefits, treatment criteria, optimal duration of therapy and risks.

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