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Length of stay in the hospital of the study population. *P<0.05; **P<0.01; ***P<0.001; LOS, length of hospital stay; Grp A, infants with birth weight=501–750 g; Grp B, infants with birth weight=751–1000 g; Grp C, infants with birth weight=1001–1250 g and Grp D, infants with birth weight=1251–1500 g.
Source publication
To evaluate the impact of initiating early nasal continuous positive airway pressure (ENCPAP) on the length of hospital stay (LOS) for the very low birth weight (VLBW) infants.
LOS at the George Washington University Hospital (GW) after the institution of ENCPAP policy was compared to benchmark values using two-tail t-tests. The incidence of neonat...
Context in source publication
Context 1
... the subgroup analyses, shorter LOS was most noticeable in the smallest subgroup of infants (a difference of 18 days in GrpA). When compared to benchmark values LOS at GW was significantly shorter for all subgroups: GrpA (86±21 vs 104±32, P ¼ 0.004), GrpB (69.9±16.7 vs 79±27, P ¼ 0.018), GrpC (48.2±13 vs 56±22, P<0.001) and GrpD (31.7±12.5 vs 40±19, P ¼ 0.003) ( Figure 2). ...
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To identify changes in mortality and neonatal morbidities for infants with birth weight 501 to 1500 g born from 2000 to 2009.
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Citations
... 5,6 LOS decreased significantly with the increase of gestational age and application of early nasal continuous positive airway pressure. 7,8 Other characteristics of newborns such as sex and delivery method also have an impact on LOS. [9][10][11] A study of very low birth weight infants reported that the LOS of males was higher than that of females. ...
Objective
To investigate the factors that influence the length of stay (LOS) in a neonatal intensive care unit (NICU).
Methods
This retrospective study analysed clinical data from all newborns hospitalized in the NICU of a tertiary hospital in the Western Hunan area of China over a 9-year period (2012–2020). Factors associated with the LOS were analysed using univariate analysis and Cox regression analysis.
Results
A total of 16 094 newborns were included in the study: of which 9615 were inborn and 6479 were outborn newborns. There were 9482 males and 6612 females. Over the 9-year period, the mean LOS was 11.08 days (median LOS, 9.00 days; range, 1–141 days); and the LOS first increased, then decreased and stabilized. A LOS of 8–28 days was the most common duration (8849 of 16 094; 54.98%). Cox regression analysis demonstrated that sex, patient source, delivery method, gestational age, birth weight and comorbidities were significantly associated with LOS.
Conclusion
Being male, low gestational age and low birth weight increased the LOS. Reducing preterm and post-term infants, as well as eliminating comorbidities, could effectively shorten the LOS of newborns.
... (17,18) Es preocupante la permanencia de prematuros en UCIN e incubadoras por 80 a 100 días cuando son de extremadamente bajo peso al nacer y presentan complicaciones. (19,20) ¿Cuál es el efecto de la falta de apego, del estrés y el dolor a que se someten a estos prematuros? Existe evidencia que a tempranas edades el eje hipotálamo hipófisis suprarrenal está funcionando y las secuelas cognitivas y conductuales parecen asociarse a futuro. ...
Introducción: Hay evidencia que prematuros sometidos a masajes tienen una mejor evolución del desarrollo psicomotriz y una mayor ganancia de peso respecto a grupos de control. El estrés, el dolor, la falta de estímulo materno en esta fase de la vida temprana podrían relacionarse a problemas cognitivos y conductuales en la adolescencia y adultez. El masaje disminuye el estrés y mejora el peso de prematuros. Objetivo: Evaluar la efectividad de la aplicación de masaje pulsátil –estímulo táctil semejando al ambiente intrauterino– sobre la ganancia de peso en bebes prematuros hospitalizados en la Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital Nacional Edgardo Rebagliati Martin. Material y métodos: Estudio prospectivo. La muestra estuvo constituida por 20 bebes prematuros de 30-34 semanas de EG. En 10 de ellos se utilizó el masaje pulsátil a través del estimulador pulsátil (Invento: Premio Medalla de Oro en Ginebra-Suiza 2000) y los otros 10 constituyen la población control. El estímulo se administró durante 7 días en la Unidad de Intermedios. Se controló peso de ingreso diariamente y peso al alta. Resultados: Se observó una ganancia promedio de peso de 33 grs. /día en el grupo estimulado y 26 grs. /día en el grupo control durante los 7 días. Existen 7 grs./día de diferencia que constituye 28.4% más de peso en el grupo estimulado. El análisis para la diferencia de pesos de los grupos con el test “t” student (SPSS 12.0) muestra un valor estadísticamente significativo (p< 0.05). Conclusiones y recomendaciones: Existe un beneficio en el peso de los prematuros sometidos a estimulación pulsátil, semejando el ambiente intrauterino. Sería recomendable su uso en prematuros y neonatos de alto riesgo en quienes no es posible realizar madre canguro y en quienes la falta de apego, el estrés y el dolor son frecuentes.
... In a randomly selected subgroup of patients from the above study, Roehr et al. 27 found improvements in lung mechanics at 8 weeks post-term in infants initially supported by early CPAP compared to those managed using early intubation and mechanical ventilation. Aly et al. 51 compared the length of hospitalization and BPD rates before and after implementation of a local policy on the use of early nCPAP for VLBW infants. The cited authors found that length of hospital stay and BPD rates were reduced when early nCPAP was employed. ...
Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia, sepsis, and trauma to the upper airways. In the last 4 decades, nasal continuous positive airway pressure (CPAP) has been used to wean preterm infants off mechanical ventilation and, more recently, as a primary mode of respiratory support for preterm infants with respiratory insufficiency. Moreover, new methods of respiratory support have been developed, and the devices used to provide non-invasive ventilation (NIV) have improved technically. Use of NIV is increasing, and a variety of equipment is available in different clinical settings. There is evidence that NIV improves gas exchange and reduces extubation failure after mechanical ventilation in infants. However, more research is needed to identify the most suitable devices for particular conditions; the NIV settings that should be used; and whether to employ synchronized or non-synchronized NIV. Furthermore, the optimal treatment strategy and the best time for initiation of NIV remain to be identified. This article provides an overview of the use of non-invasive ventilation (NIV) in newborn infants, and the clinical applications of NIV.
... Vanpee et al. [30] recently compared two nurseries and found that although the rates of BPD were similar, a North American unit, with a policy of intubating all infants delivered earlier than 28 weeks' gestation, had a higher rate of oxygen treatment at 40 weeks than a Scandinavian unit where most were started on NCPAP. Aly et al. [31] compared the length of stay and BPD rates in one institution before and after a change in policy towards initiating early NCPAP for verylow-birth weight (VLBW) infants. They found that both length of stay and BPD were reduced when early NCPAP was used. ...
To present recent data on the role of noninvasive ventilation in the respiratory management of newborn infants.
Noninvasive ventilation is growing in popularity but is applied using widely varying devices and settings. Although short-term physiological advantages were reported for bubble and variable-flow continuous positive airways pressure, neither has convincingly shown superior clinically important outcomes. Continuous positive airways pressure may be used as the initial mode of support for very preterm infants but increased rates of pneumothorax in infants not receiving surfactant are a concern. Methods of administering surfactant without endotracheal intubation deserve further study. Nasal intermittent positive-pressure ventilation shows promise as a primary treatment for respiratory distress syndrome. Optimal pressure settings for continuous positive airways pressure and nasal intermittent positive-pressure ventilation remain uncertain.
Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.
... A later comparison conducted at Columbia University confirmed the decreased incidence of BPD. 12 NICUs in and outside the United States have reported their experiences with lower incidence of BPD using CPAP when compared with their own historical outcomes or current national benchmark values. 2,[13][14][15] The strength of evidence of these reports is not adequate, because they were not originally designed as randomized, controlled trials. However, it is important to remember that the absence of evidence is not evidence of absence. ...
Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use. This is a comprehensive review that seeks to address the different complications that are associated with the incorrect use of nCPAP highlighting that these are operator-related and not device-related.
Objective:
Delivery room management interventions have been successfully implemented via collaborative quality improvement (QI) projects. However, it is unknown whether these successes translate to reductions in neonatal morbidity and mortality.
Study design:
This was a prospective pre-post intervention study of three nonrandomized hospital groups within the California Perinatal Quality Care Collaborative. A collaborative QI model (Collaborative QI) was compared with a single-site QI model (NICU QI) and a non-participant population when implementing evidence-based delivery room practices. The intervention period was between June 2011 and May 2012. Infants born with gestational age between 22 weeks 0 days and 29 weeks 6 days and birth weight ⩽1500 g were included. Outcomes were mortality and select morbidities (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC)). Outcomes were compared between the baseline (January 2010 to May 2011) and post-intervention period (June 2012 to May 2013) within each comparison group.
Results:
Ninety-five hospitals were included with 4222 infants in the baseline period and 4186 infants in the post-intervention period. The Collaborative QI group had significantly reduced odds of developing BPD post-intervention (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.65 to 0.99) or composite BPD-death (OR 0.83, 95% CI 0.69 to 1.00). In both the Collaborative QI and non-participants there were also reductions in IVH, severe IVH, composite severe IVH-death, severe ROP and composite severe ROP-death.
Conclusion:
Hospitals dedicated to improving delivery room practices can impact neonatal outcomes.Journal of Perinatology advance online publication, 22 December 2016; doi:10.1038/jp.2016.237.
Objective: Evaluation of the incidence of bronchopulmonary dysplasia (BPD) and other comorbidities on the basis of initial ventilation management in the delivery room. Methods: Retrospective analysis of data from newborns born at Clinic of Neonatology University Hospital Nove Zamky, at 24th-27th weeks of gestation, from birth until discharge, during the period from 01.01.2005 to 31.12.2009. Patients were infants who were in the delivery room initially intubated and prophylactic surfactant was administered followed by N-CPAP (nasal continuous positive pressure in pulmonary passages) and babies who after surfactant administration continued on mechanical ventilation. In addition, the incidence of various types of BPD (classification according to NICHD, National Institute of Child Health and Human Development), comorbidities, length of hospitalization, and administration of postnatal steroids were observed in both groups. Results: The results of our retrospective analysis showed significantly lower incidence of mild forms of BPD in the group of newborns with gestation 24+0 to 27+6 weeks initially stabilized by early administration of surfactant and N-CPAP compared with newborn stabilized by early surfactant administration followed by mechanical ventilation (25% vs. 70%; p=0.001). The incidence of secondary forms of BPD was lower in group N-CPAP compared with MV (5% vs. 12.5%, p=0.361). Conclusion: Immediate extubation after surfactant administration to N-CPAP in neonates with gestation 24+0 to 27+6 weeks has shown decrease in the incidence of BPD, and other comorbidities as well as in shortening the length of hospitalization.
The use of early nasal continuous positive airway pressure (ENCPAP) as the mode of initial respiratory support for very low birth weight (VLBW) infants has been increasing. The impact of CPAP and oxygen on gut mucosa and perfusion in premature infants is not known. The relation between ENCPAP and necrotizing enterocolitis (NEC) has not been adequately addressed.
To evaluate if the use of an individualized respiratory management strategy encouraging the use of ENCPAP is associated with an increased risk of NEC, and to determine risk factors for NEC in premature infants supported by CPAP.
A retrospective analysis was conducted on VLBW infants (birth weight < 1500 g) managed at 2 institutions that use an ENCPAP respiratory management strategy for premature infants. Data on the use of oxygen and mode of ventilatory support were collected during the first 3 days of life. Diagnosis of NEC was used as the dependent variable in a logistic regression model. Birth weight, gender, prenatal steroid use, mode of respiratory support (CPAP versus ventilator) and fraction of inspired oxygen, umbilical artery catheter placement, partial pressure of oxygen, patent ductus arteriosus, early sepsis, hospital, and delivery room management (ENCPAP versus initial intubation) were controlled for in the model.
Data on 343 premature infants were collected for this study. Mean birth weight was 999 +/- 289 g and gestational age was 28 +/- 2.6 weeks. The majority of patients were managed with ENCPAP, with only 13% of patients intubated in the delivery room. The overall incidence of NEC was 7% (n = 24). The exposure to ENCPAP did not increase the risk for NEC compared with the use of a ventilator. CONCLUSIONS. The risk of NEC in VLBW premature infants was not increased by the use of ENCPAP. Initial respiratory support with ENCPAP seems to be a safe alternative to routine intubation and mechanical ventilation in premature infants.
Initial ventilation strategy may play an important role in the development of bronchopulmonary dysplasia in very preterm infants. Early nasal continuous positive airway pressure is an accepted approach, but randomized clinical trials are lacking. Our aim was to determine whether early nasal continuous positive airway pressure, preceded by a sustained inflation, is more effective and less injurious in very preterm infants than conventional intervention.
Two hundred seven very preterm infants were assigned randomly in the delivery room to either a sustained inflation through a nasopharyngeal tube followed by early nasal continuous positive airway pressure (early functional residual capacity intervention) or repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure, if necessary, after arrival at the NICU. The primary outcome measure was intubation <72 hours of age and bronchopulmonary dysplasia at 36 weeks was used as secondary outcome. This trial was registered as an early functional residual capacity intervention trial (ISRCTN 12757724).
In the early functional residual capacity intervention group, fewer infants were intubated at <72 hours of age or received >1 dose of surfactant, and the average duration of ventilatory support was less. Infants in the early functional residual capacity intervention group developed bronchopulmonary dysplasia less frequently.
A sustained inflation followed by early nasal continuous positive airway pressure, delivered through a nasopharyngeal tube, is a more efficient strategy than repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure on admission to the NICU.
