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.