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Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit
Joint Authors
Govindaswami, Balaji
Nudelman, Matthew
Narasimhan, Sudha Rani
Huang, Angela
Misra, Sonya
Urquidez, Gilbert
Kifle, Alganesh
Stemmle, Monica
Angell, Cathy
Patel, Rupalee
Anderson, Christina
Song, Dongli
DeSandre, Glenn
Jegatheesan, Priya
Byrne, James
Source
Issue
Vol. 2019, Issue 2019 (31 Dec. 2019), pp.1-14, 14 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2019-01-13
Country of Publication
Egypt
No. of Pages
14
Main Subjects
Abstract EN
Introduction.
Avoiding intubation and promoting noninvasive modes of ventilator support including continuous positive airway pressure (CPAP) in preterm infants minimizes lung injury and optimizes neonatal outcomes.
Discharge home on oxygen is an expensive morbidity in very preterm infants (VPI) with lung disease.
In 2007 a standardized bundle was introduced for VPI admitted to the neonatal care unit (NICU) which included delayed cord clamping (DCC) at birth and noninvasive ventilation as first-line cardiorespiratory support in the delivery room (DR), followed by bubble CPAP upon NICU admission.
Objective.
Our goal was to evaluate the risk of (1) intubation and (2) discharge home on oxygen after adopting this standardized DR bundle in VPI born at a regional perinatal center and treated in the NICU over a ten-year period (2008-2017).
Materials and Methods.
We compared maternal and neonatal demographics, respiratory care processes and outcomes, as well as neonatal mortality and morbidity in VPI (< 33 weeks gestation) and extremely low birth weight (ELBW, < 1000 g) subgroup for three consecutive epochs: 2008-2010, 2011-2013, and 2014-2017.
Results.
Of 640 consecutive inborn VPI, 55% were < 1500 g at birth and 23% were ELBW.
Constant through all three epochs, DCC occurred in 83% of VPI at birth.
There was progressive increase in maternal magnesium during the three epochs and decrease in maternal antibiotics during the last epoch.
Over the three epochs, VPI had less risk of DR intubation (23% versus 15% versus 5%), NICU intubation (39% versus 31% versus 18%), and invasive ventilation (37% versus 30% versus 17%), as did ELBW infants.
Decrease in postnatal steroid use, antibiotic exposure, and increase in early colostrum exposure occurred over the three epochs both in VPI and in ELBW infants.
There was a sustained decrease in surfactant use in the second and third epochs.
There was no significant change in mortality or any morbidity in VPI; however, there was a significant decrease in pneumothorax (17% versus 0%) and increase in survival without major morbidity (15% versus 41%) in ELBW infants between 2008-2010 and 2014-2017.
Benchmarked risk-adjusted rate for oxygen at discharge in a subgroup of inborn VPI (401-1500 g or 22-31 weeks of gestation) is 2.5% (2013-2017) in our NICU compared with > 8% in all California NICUs and > 10% in all California regional NICUs (2014-2016).
Conclusion.
Noninvasive strategies in DR and NICU minimize risk of intubation in VPI without adversely affecting other neonatal or respiratory outcomes.
Risk-adjusted rates for discharge home on oxygen remained significantly lower for inborn VPI compared with rates at regional NICUs in California.
Reducing intubation risk in ELBW infants may confer an advantage for survival without major morbidity.
Prenatal magnesium may reduce intubation risk in ELBW infants.
American Psychological Association (APA)
Govindaswami, Balaji& Nudelman, Matthew& Narasimhan, Sudha Rani& Huang, Angela& Misra, Sonya& Urquidez, Gilbert…[et al.]. 2019. Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit. BioMed Research International،Vol. 2019, no. 2019, pp.1-14.
https://search.emarefa.net/detail/BIM-1126383
Modern Language Association (MLA)
Govindaswami, Balaji…[et al.]. Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit. BioMed Research International No. 2019 (2019), pp.1-14.
https://search.emarefa.net/detail/BIM-1126383
American Medical Association (AMA)
Govindaswami, Balaji& Nudelman, Matthew& Narasimhan, Sudha Rani& Huang, Angela& Misra, Sonya& Urquidez, Gilbert…[et al.]. Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit. BioMed Research International. 2019. Vol. 2019, no. 2019, pp.1-14.
https://search.emarefa.net/detail/BIM-1126383
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1126383