Original ArticleVariables Associated with the Early Failure of Nasal CPAP in Very Low Birth Weight Infants
Section snippets
Methods and Design
“Bubble” nasal CPAP is routinely used at the Children's Hospital of New York, Columbia University as an initial respiratory support modality in spontaneously breathing VLBW infants with RDS. Following resuscitation (if needed) and stabilization at delivery, VLBW infants are immediately carried to the transitional nursery within the delivery suite, where CPAP is applied to those with spontaneous respiratory effort within 5 to 10 minutes of birth.1 The initial respiratory support modality for
Statistical Analysis
To characterize the risks for early CPAP failure, three comparisons were made based on the infant's initial and eventual respiratory care group: ventilator-started versus CPAP-started; ventilator-started versus CPAP failure; and CPAP failure versus CPAP success. Because many of the variables used are not normally distributed, median values and their corresponding 95% CI for each group are reported.13 P values for post hoc comparisons were obtained from individual comparisons using Mann-Whitney
Respiratory Care Groups
Following initial resuscitation and stabilization in the delivery room and the transitional nursery, 229 (88%) infants were placed on nasal CPAP (the CPAP-started group) and 32 (12%) infants were started on mechanical ventilation (the ventilator-started group) as initial respiratory support modalities. Of ventilator-started infants, 29 of 32 (91%) underwent endotracheal intubation in the delivery room; the remaining three infants underwent endotracheal intubation on admission to the
Discussion
Progress in neonatal intensive care is closely related to improvements in the management of respiratory failure in small infants. Current modalities of ventilatory assistance range from CPAP to various modes of mechanical ventilation. The advent of less invasive methods of delivering CPAP to infants with RDS is associated with reduced need for intubation and mechanical ventilation and a lower incidence of CLD.1, 15, 16 The clinical outcomes for infants who succeed on CPAP are excellent, with
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