title: Is the use of early nasal CPAP associated with lower rates of chronic lung disease and retinopathy of prematurity? Nine years of experience with the Vermont Oxford Neonatal Network.
abstract: OBJECTIVE
  The neonatal regional tertiary care center of the University of Vienna (VC) has been a member of the Vermont Oxford Neonatal Network (VONN) since 1994. During the period 1994--2002, important differences between the VC and the VONN in both pre- and postnatal management and in late morbidities such as chronic lung disease (CLD) and severe retinopathy of prematurity (ROP) were observed. We hypothesize that stabilization of very-low-birth-weight (VLBW) infants on nasal continuous positive airway pressure (NCPAP) immediately after birth, combined with a restrictive use of artificial ventilation, might be responsible for lower rates of CLD and ROP.
  
  
  METHODS
  Obstetric and neonatal data for all 1299 VLBW infants (401-1500 g) from the VC were compared with corresponding data for the 201,167 VLBW infants from the VONN for the period 1994--2002 with regard to respiratory management and patient outcome. Morbidity criteria were in accordance with VONN definitions.
  
  
  RESULTS
  The percentage range for treatment and morbidity criteria for the VC and VONN are related to differences among various years within the observation period. Infants were stabilized at birth on NCPAP in 45-86% of cases in the VC vs. 37-63% in the VONN, the rate of mechanical ventilation was 40-59% vs. 66-74%, and use of surfactant was 31-50% vs. 55-64%. CLD was diagnosed in 14-32% of cases in the VC vs. 27-39% in the VONN, discharge on supplemental oxygen took place in 2-4% vs. 12-17% of cases and ROP (stages III and IV) was found in 1-10% vs. 8-12%.
  
  
  CONCLUSIONS
  The association of lower rates of CLD and ROP in the VC compared to the VONN might be related to differences in early respiratory management of VLBW infants at high risk of development of respiratory distress syndrome. This needs to be confirmed in a large multicenter trial.
authors.affiliation: Department of Pediatrics, University of Vienna, Vienna, Austria.
authors.forename: Lieselotte
authors.initials: L
authors.lastname: Kirchner
authors.forename: Manfred
authors.initials: M
authors.lastname: Weninger
authors.forename: Lukas
authors.initials: L
authors.lastname: Unterasinger
authors.forename: Robert
authors.initials: R
authors.lastname: Birnbacher
authors.forename: Michael
authors.initials: M
authors.lastname: Hayde
authors.forename: Reinhard
authors.initials: R
authors.lastname: Krepler
authors.forename: Arnold
authors.initials: A
authors.lastname: Pollak
mesh_terms: D001317:Austria / Q000453:epidemiology; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology* / Q000209:etiology; D045422:Continuous Positive Airway Pressure; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D012178:Retinopathy of Prematurity / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies