1351 Five Years Experience with Ncpap as the Standard of Practice in Poland

Abstract

Objective: We hypothesized that nCPAP could be applied successfully across our country and that gathering of relevant data would identify factors associated with successful treatment. Methods: We implemented a program in 2003 to establish general use of nCPAP as the standard of practice. The variable flow Infant Flow was selected as the system of choice. A registry of the baseline, course of treatment and outcome of all infants treated with nCPAP was established. In this analysis we present our experience with 11,476 neonates treated with nCPAP over the first 5 year period. Results: 41% of the infants were between 1000- 2000 grams, 14% below and 45% above. Most of the infants were treated to avoid intubation (67% RDS, 12% other, 5% apnea), and the balance to avoid reintubation when weaning from mechanical ventilation. The percentage of infants in the weaning category decreased as elective intubation decreased. nCPAP treatment successfully avoided intubation or reintubation 84% of the time. Multivariate analysis revealed that treatment success was not only associated with diagnostic category, weight and EGA, but also Apgar score at 5 minutes, pH>7.25 and PaO2/FiO2>150. The incidence of pneumothorax was highest in infants larger than 1000 grams being treated to avoid intubation, but still only 2.2%. Multivariate analysis revealed that pneumothorax in this group was associated with Apgar score at 5 minutes, pH< 7.25 and PaO2/FiO2< 150. Conclusions: We successfully established nCPAP as a standard of practice in Poland. We identified baseline factors associated with bad outcomes.