Original Article

Journal of Perinatology (2006) 26, 189–196. doi:10.1038/sj.jp.7211454; published online 2 February 2006

Early variable-flow nasal continuous positive airway pressure in infants less than or equal to1000 grams at birth

P Jegatheesan1, R L Keller1 and S Hawgood1,2

  1. 1Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
  2. 2Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA

Correspondence: Dr RL Keller, Department of Pediatrics, University of California San Francisco, UCSF Box 0748, 533 Parnassus Avenue, U585, San Francisco, CA, 94143-0748, USA. E-mail: kellerr@peds.ucsf.edu

Received 25 October 2005; Revised 27 December 2005; Accepted 3 January 2006; Published online 2 February 2006.

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Abstract

Objective:

 

To compare the incidence of chronic lung disease (CLD) in extremely low birth weight (ELBW, less than or equal to1000 g) infants before and after the introduction of early, preferential application of nasal continuous airway pressure (NCPAP) utilizing a variable flow delivery system.

Study design:

 

A retrospective cohort study of ELBW infants 2 years prior to (Pre-early NCPAP, n=96) and 2 years following (Early NCPAP, n=75) the initiation of an early NCPAP policy.

Results:

 

There were no significant changes (Pre-early NCPAP vs Early NCPAP) in the incidences of CLD (35 vs 33%, P=0.81) or CLD or death (50 vs 43%, P=0.34). Infants in the Early NCPAP group weaned off mechanical ventilation and supplemental oxygen more rapidly than infants in the Pre-early NCPAP group (hazard ratio (HR) 1.80, P=0.002 and HR 1.69, P=0.01).

Conclusion:

 

A policy of early NCPAP has not decreased the incidence of CLD despite a decrease in time to successful tracheal extubation.

Keywords:

chronic lung disease, bronchopulmonary dysplasia, ventilator-induced lung injury

Abbreviations:

BW, birth weight; CLD, chronic lung disease; DR, delivery room; ELBW, extremely low birth weight; FiO2, fraction of inspired oxygen; GA, gestational age; ICH, intracranial hemorrhage; NCPAP, nasal continuous positive airway pressure; NEC, necrotizing enterocolitis; O2, oxygen; PDA, patent ductus arteriosus; PMA, post-menstrual age; RDS, respiratory distress syndrome; SIMV, synchronized intermittent mandatory ventilation; SpO2, oxygen saturation measured by pulse oximety; VT, tidal volume.

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