| Title | Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes. | | Author(s) | Bhandari V, Finer NN, Ehrenkranz RA, Saha S, Das A, Walsh MC, Engle WA, VanMeurs KP, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network | | Institution | Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. vineet.bhandari@yale.edu | | Source | Pediatrics 2009 Aug; 124(2):517-26. | | MeSH | Birth Weight
Brain Damage, Chronic
Bronchopulmonary Dysplasia
Cause of Death
Continuous Positive Airway Pressure
Gestational Age
Hospital Mortality
Hospitals, Pediatric
Hospitals, University
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Very Low Birth Weight
Intermittent Positive-Pressure Ventilation
Oxygen Inhalation Therapy
Respiratory Distress Syndrome, Newborn
Retrospective Studies
Survival Rate
Ventilator Weaning
| | Abstract | BACKGROUND: Synchronized nasal intermittent positive-pressure ventilation (SNIPPV) use reduces reintubation rates compared with nasal continuous positive airway pressure (NCPAP). Limited information is available on the outcomes of infants managed with SNIPPV.
OBJECTIVES: To compare the outcomes of infants managed with SNIPPV (postextubation or for apnea) to infants not treated with SNIPPV at 2 sites.
METHODS: Clinical retrospective data was used to evaluate the use of SNIPPV in infants <or=1250 g birth weight (BW); and 3 BW subgroups (500-750, 751-1000, and 1001-1250 g, decided a priori). SNIPPV was not assigned randomly. Bronchopulmonary dysplasia (BPD) was defined as treatment with supplemental oxygen at 36 weeks' postmenstrual age.
RESULTS: Overall, infants who were treated with SNIPPV had significantly lower mean BW (863 vs 964 g) and gestational age (26.4 vs 27.9 weeks), more frequently received surfactant (85% vs 68%), and had a higher incidence of BPD or death (39% vs 27%) (all P < .01) compared with infants treated with NCPAP. In the subgroup analysis, SNIPPV was associated with lower rates of BPD (43% vs 67%; P = .03) and BPD/death (51% vs 76%; P = .02) in the 500- to 750-g infants, with no significant differences in the other BW groups. Logistic regression analysis, adjusting for significant covariates, revealed infants with 500-700-g BW who received SNIPPV were significantly less likely to have the outcomes of BPD (OR: 0.29 [95% CI: 0.11-0.77]; P = .01), BPD/death (OR: 0.30 [95% CI: 0.11-0.79]; P = .01), neurodevelopmental impairment (NDI) (OR: 0.29 [95% CI: 0.09-0.94]; P = .04), and NDI/death (OR: 0.18 [95% CI: 0.05-0.62]; P = .006).
CONCLUSION: SNIPPV use in infants at greatest risk of BPD or death (500-750 g) was associated with decreased BPD, BPD/death, NDI, and NDI/death when compared with infants managed with NCPAP. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
| | PubMed ID | 19651577 |
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