The Columbia (New York) system of neonatal respiratory management (early optimal nasal continuous positive airway pressure [CPAP], with aggressive weaning from mechanical ventilation [IMV], when required) produces significant reductions in pulmonary morbidity. Other centers have had difficulty reproducing the system and outcomes. The Columbia system was introduced at Middlemore in June 1996, adhering closely to their principles and practices. We compare all inborn neonates birthweight 1000-1500g managed conventionally(early intubation, IMV, and surfactant administration for significant respiratory distress) between 4/1/93 and 5/31/96, with those managed with the Columbia system from 6/1/96 to 11/30/97. Statistics for days of IMV, CPAP, and oxygen are calculated on all babies who required one or more forms of respiratory support.

Conclusions: The Columbia neonatal respiratory management system, rigorously applied, reproducibly and markedly reduces the need for invasive respiratory support and the need for supplemental oxygen at 28 days of life in VLBW infants. In addition, there are trends to reductions in neurologic and other neonatal morbidities. Table

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