Provision of bubble continuous positive airway pressure for the stabilisation of extremely and very preterm infants after birth: A single-centre experience

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health Pub Date : 2024-07-03 DOI:10.1111/jpc.16608

Nele Legge, Dominic Fitzgerald, Himanshu Popat

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引用次数: 0

Abstract

Aim

To describe the effect of resuscitation with bubble CPAP (bCPAP) versus T-piece device at birth on early clinical parameters and hospital outcomes in infants born <32 weeks gestation.

Methods

This is a single-centre pre- and post-implementation study comparing outcomes in two epochs. In epoch 1 (1 July 2013–31 December 2014), infants were managed with non-humidified gas using Neopuff® T-piece devices to support breathing after birth. In epoch 2 (1 March 2020–31 December 2021), routine application of bCPAP with humidified gas was introduced at birth.

Results

Three hundred fifty-seven patients were included (176 epoch 1, 181 epoch 2). The mean gestational age was 28 ± 2 weeks. The demographics of the two epochs were comparable. There were significant improvements in outcomes of infants in epoch 2 with less infants intubated at delivery (16% vs. 4%, P ≤ 0.001), improved 5 min Apgar (7 vs. 8, P ≤ 0.001), reduced need for ventilation (21% vs. 8.8%, P ≤ 0.001), duration of ventilation in the first 72 h (9.6 vs. 4.6 h) and mortality (10.8% vs. 1.7%, P ≤ 0.001). There was, increased incidence of chronic lung disease (30% vs. 55%, P = 0.02) but no increase in infants discharged on oxygen (3.8% vs. 5%, P = 0.25). Similar findings were observed in a subgroup of infants born <25 weeks' gestation with no increase in the incidence of CLD.

Conclusion

Introducing application of bCPAP from the first breaths in infants <32 weeks' gestation was associated with better short-term outcomes and mortality, albeit with increased incidence of CLD. The subgroup of infants born <25 weeks' gestation showed similar change in outcomes, with no increase in CLD.

Abstract Image

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在极早产儿和超早产儿出生后提供气泡持续正压呼吸以稳定病情：单中心经验。

目的：描述在婴儿出生时使用气泡式 CPAP（bCPAP）和 T 片式设备进行复苏对婴儿早期临床参数和住院治疗效果的影响方法：这是一项实施前和实施后的单中心研究，比较两个时期的治疗效果：这是一项单中心研究，比较两个阶段实施前和实施后的结果。在第一阶段（2013 年 7 月 1 日至 2014 年 12 月 31 日）中，婴儿出生后使用 Neopuff® T 片式装置以非湿化气体支持呼吸。在第二阶段（2020 年 3 月 1 日至 2021 年 12 月 31 日），婴儿出生后常规使用带加湿气体的 bCPAP：结果：共纳入 357 例患者（176 例病程 1，181 例病程 2）。平均胎龄为 28±2 周。两个阶段的人口统计学特征相当。第 2 阶段的婴儿预后明显改善，分娩时插管的婴儿减少（16% 对 4%，P≤0.001），5 分钟 Apgar 有所改善（7 对 8，P≤0.001），通气需求减少（21% 对 8.8%，P≤0.001），前 72 小时的通气持续时间（9.6 对 4.6 小时）和死亡率（10.8% 对 1.7%，P≤0.001）。慢性肺病的发病率有所增加（30% 对 55%，P = 0.02），但吸氧出院的婴儿人数没有增加（3.8% 对 5%，P = 0.25）。在一组出生婴儿中也观察到了类似的结果：从婴儿的第一次呼吸开始使用 bCPAP

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来源期刊

Journal of paediatrics and child health 医学-小儿科

CiteScore

2.90

自引率

5.90%

发文量

487

审稿时长

3-6 weeks

期刊介绍： The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.