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The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institution.

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.

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  • 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