The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

NASAL CPAP FOR INITIAL STABILIZATION IN VERY LOW BIRTH WEIGHT INFANTS.

Shayne Morris2,1, Heloisa Georgiev2, Dr. Thomas Wiswell1, Terry Cavanagh1, Vicki Flynn1; 1Neonatal Intensive Care Unit, Florida Hospital for Children, Orlando, FL; 2Respiratory Care, Florida Hospital for Children, Orlando, FL

Background: Bronchopulmonary dysplasia (BPD) has plagued neonatal intensive care units since the 1960s. Injury to the lungs during the first hours and days of life plays a major role in the development of BPD, particularly in the very low birth weight (VLBW) premature infant. Despite significant decreases in mortality following widespread use of exogenous surfactant, there has not been a concomitant decline in BPD. Continuous positive airway pressure (CPAP) represents a gentle mode of respiratory support that is in widespread use in neonatal intensive care units. We proposed that early use of nasal CPAP, solely or in conjunction with exogenous surfactant, could potentially mitigate the development of BPD through the reduction of barotrauma associated with mechanical ventilation. In turn this could lead to a shorter length of stay and reduce the morbidity and mortality associated with premature birth, potentially enhancing an infant’s quality of life. Purpose/Aim: By December, 2010, all inborn infants meeting established criteria who are between 750-1250 grams and less than 32 weeks, 6 days gestation will only be intubated for surfactant administration. To give infants the best chance at remaining off mechanical ventilation, the following protocols will be initiated: Initiating nasal CPAP PEEP of +6 & increasing to +8 if needed Initiating caffeine therapy immediately after birth Using chin straps to maintain CPAP Inserting a ventilation orogastric tube (6.5 French) Accepting liberalized PC02s Following surfactant administration guidelines. Methods: The study was conducted at a 61 bed urban NICU in the southeastern United States. Developed flowsheet to be completed on every inborn infant weighing between 750-1250 grams to document: Gestational Age, Birth weight, Sex, Apgars Administration of Prenatal Steroids Surfactant Administration at birth Included in study Rationale if not included in study Description of Resuscitation Conclusion PDSA cycles yielded data from 23 infants who met the established criteria for stabilization on nasal CPAP within a 18 week period 73% of infants weighing between 750-1250 grams were successfully stabilized on nasal CPAP Sponsored Research - None