239 Delivery Room Intubation, Mechanical Ventilation and Bronchopulmonary Dysplasia Among Tertiary-Level Neonatal Units in Northern Italy

Abstract

Background: Bronchopulmonary dysplasia (BPD) remains a significant complication of prematurity, and wide variations of BPD rates in different neonatal units have been reported. These differences have been ascribed to different practices, especially in mechanical ventilation.Since mechanical ventilation is often started in the delivery room (DR), we wanted to investigate if different approaches to DR intubation affected the development of BPD. Methods: We examined a cohort of 1338 newborns, with birthweight < 1500g (mean 1086 g) and gestational age < 32 weeks (mean 28.7 weeks), admitted to 12 tertiary-level neonatal units in Lombardy (Northern Italy) participating in a local network in 1999–2002 and surviving to 36 weeks; 226 (16,1%) developed BPD defined as oxygen need at 36 weeks. Results: BPD rates significantly differed between hospitals (from 8.5% to 27.7%), as well as rates of intubation in the DR (from 28.8% to 73.6%), and rates of mechanical ventilation (from 32.2% to 84%). Centers with high intubation rates had higher ventilation (R2 = 0.7, linear regression analysis) and higher BPD (R2 = 0.35) rates. In univariate analysis, intubation in the DR was associated with increased risk of BPD (odds ratio 5.9), while surfactant administration did not affect BPD.Differences in individual infants characteristics (GA, BW, antenatal steroids, CRIB score) did not explain the differences in intubation rates across centers. Differences between centers were highly significant (P<0.001, logistic regression) Conclusions: These results support the hypothesis that differences in initial management of VLBWI between hospitals partly explain differences in BPD, and that these differences are not explained by case-mix, but probably by different policies of treatment. Moreover, this enlights the problem of a wide variation in practices, that deserves further investigation. In these situations, potentially better practices, including a more selective approach to the endotracheal intubation in the DR, could achieve better clinical results.