Abstract

BACKGROUND AND OBJECTIVE
Nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) with the option of back-up ventilation for those infants for whom noninvasive ventilatory support failed resulted in a significant increase in survival in extremely low birth weight (ELBW) infants. The authors sought to determine the outcome of ELBW infants treated with NCPAP and InSurE in a neonatal high care ward with limited back-up ventilation.
METHODS
Three hundred eighteen inborn infants with birth weight 500-1000 g and gestational age ≥25 weeks who were admitted to the neonatal high care ward were included in this observational study. InSurE was administered to infants with respiratory distress syndrome on NCPAP who had severe in-drawing and recession, apneic spells, or an Fio(2) >0.4 within 1 hour of birth.
RESULTS
Two hundred twelve (68.6%) infants could be treated with NCPAP only and 97 (31.4%) required InSurE. Seventeen infants were admitted to the NICU; 90%, 87%, and 74.8% of the infants survived until day 3, 7, and discharge, respectively. Only 2 infants developed a pneumothorax and 2 had chronic lung disease. Seventy-nine percent of the infants of ≥750 g or >26 weeks' gestation survived to discharge compared with 56% and 60% of the infants of <750 g or ≤26 weeks' gestation, respectively. Maternal antenatal steroid administration contributed significantly to the survival of the infants (P = 0.0017, odds ratio 2.7, 95% confidence interval 1.44-5.07).
CONCLUSIONS
The use of NCPAP and InSurE in a neonatal high care ward with limited resources can improve the survival of ELBW infants. Maternal antenatal steroid administration contributed significantly to survival.

Links

Publisher Full Text

Authors

Kirsten GF, Kirsten CL, Henning PA, Smith J, Holgate SL, Bekker A, Kali GT, Harvey J

Institution

Division of Neonatology, Tygerberg Children’s Hospital, Western Cape, South Africa. gfk@sun.ac.za

Source

Pediatrics 129:4 2012 Apr pg e952-9

MeSH

Airway Extubation
Continuous Positive Airway Pressure
Female
Follow-Up Studies
Gestational Age
Hospital Mortality
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Intubation, Intratracheal
Male
Respiratory Distress Syndrome, Newborn
Retrospective Studies
South Africa
Survival Rate
Treatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22430447