Abstract
BackgroundContinuous positive airway pressure (CPAP) is used widely to provide respiratory support for neonates, and is often the first treatment choice in tertiary centres. Recent trials have demonstrated that CPAP reduces need for intubation and ventilation for infants born at 25-28 weeks gestation, and at > 32weeks, in non-tertiary hospitals, CPAP reduces need for transfer to NICU. The aim of this study was to examine recent population trends in the use of neonatal continuous positive airway pressure.MethodsWe undertook a population-based cohort study of all 696,816 liveborn neonates ≥24 weeks gestation in New South Wales (NSW) Australia, 2001-2008. Data were obtained from linked birth and hospitalizations records, including neonatal transfers. The primary outcome was CPAP without mechanical ventilation (via endotracheal intubation) between birth and discharge from the hospital system. Analyses were stratified by age ≤32 and > 32 weeks gestation.ResultsNeonates receiving any ventilatory support increased from 1,480 (17.9/1000) in 2001 to 2,486 (26.9/1000) in 2008, including 461 (5.6/1000) to 1,465 (15.8/1000) neonates who received CPAP alone. There was a concurrent decrease in mechanical ventilation use from 12.3 to 11.0/1000. The increase in CPAP use was greater among neonates > 32 weeks (from 3.2 to 11.8/1000) compared with neonates ≤32 weeks (from 18.1 to 32.7/1000). The proportion of CPAP > 32 weeks initiated in non-tertiary hospitals increased from 6% to 30%.ConclusionsThe use of neonatal CPAP is increasing, especially > 32 weeks gestation and among non-tertiary hospitals. Recommendations are required regarding which infants should be considered for CPAP, resources necessary for a unit to offer CPAP and monitoring of longer term outcomes.
Highlights
Continuous positive airway pressure (CPAP) is used widely to provide respiratory support for neonates, and is often the first treatment choice in tertiary centres
Between 2002 and 2006, Buckmaster and colleagues conducted an randomized controlled trials (RCTs) comparing CPAP with headbox oxygen for neonates > 31 weeks born in nontertiary hospitals and found CPAP reduced the need for transfer to a neonatal intensive care unit (NICU) [6]
Among infants who required respiratory support, those with transient tachypnea were more than twice as likely to be managed with CPAP alone (RR = 2.5; 95% CI 2.3-2.7) compared to those with other diagnoses; 65% of infants with transient tachypnea as one of their admitting diagnoses and requiring respiratory support received CPAP alone
Summary
Continuous positive airway pressure (CPAP) is used widely to provide respiratory support for neonates, and is often the first treatment choice in tertiary centres. Recent trials have demonstrated that CPAP reduces need for intubation and ventilation for infants born at 25-28 weeks gestation, and at > 32weeks, in nontertiary hospitals, CPAP reduces need for transfer to NICU. The aim of this study was to examine recent population trends in the use of neonatal continuous positive airway pressure. Between 2002 and 2006, Buckmaster and colleagues conducted an RCT comparing CPAP with headbox oxygen for neonates > 31 weeks born in nontertiary hospitals and found CPAP reduced the need for transfer to a neonatal intensive care unit (NICU) [6]. Trials in very preterm babies published since 2008 suggest that starting CPAP at birth may have important benefits, with 50% of babies 25-28 weeks gestation never requiring intubation and ventilation, and that neonates of this gestational age who commence CPAP from birth have no increased risk of death or bronchopulmonary dysplasia, and are less likely to be on oxygen at 28 days of age [7,8]. An additional aim was to assess whether CPAP use changed in hospitals that participated in the Buckmaster CPAP trial [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
