title: Effect of introduction of synchronized nasal intermittent positive-pressure ventilation in a neonatal intensive care unit on bronchopulmonary dysplasia and growth in preterm infants.
abstract: The objective of this study was to evaluate the incidence of bronchopulmonary dysplasia (BPD), nutritional intake, and growth in premature infants receiving synchronized nasal intermittent positive-pressure ventilation (SNIPPV) versus nasal continuous positive airways pressure (NCPAP) after extubation, at an institution with no prior experience with SNIPPV. This was a retrospective case-control study of infants (born May 2000 to December 2003) at < or = 32 weeks gestation. Extubation to SNIPPV was performed in accordance with a standardized protocol. Infants in the control group were extubated to NCPAP, as per standard nursery practice. There were no significant differences in the maternal characteristics, antenatal corticosteroid use, mode of delivery, gestational age, birthweight, male gender, Apgar scores at 1 and 5 minutes, number of surfactant doses, and duration of endotracheal tube PPV between infants in the control group (n = 30) and those extubated to SNIPPV (n = 30). The duration of NCPAP (median [range]: control versus SNIPPV, 601 [24 to 1270] versus 230.5 [36 to 1200] hours; P < 0.001) and supplemental oxygen (mean +/- standard error of the mean: 84.10 +/- 6.43 versus 63.68 +/- 5.34 days; p = 0.02) was significantly lower in the SNIPPV group. The number of infants with BPD was significantly less in the SNIPPV group (73% versus 40%; p < 0.01). There were no differences between the two groups in total days on parenteral nutrition, caloric intake (total, carbohydrate, protein, or fat), or weight gain. Our results show that introduction of SNIPPV in a neonatal intensive care unit resulted in infants having significantly less need for supplemental oxygen and decreased BPD, without affecting their weight gain or the incidence of other short-term morbidities.
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, Connecticut 06520-8064, USA.
authors.forename: Ameya
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: Vineet
authors.initials: V
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000628:therapy*; D016022:Case-Control Studies; D002908:Chronic Disease; D002149:Energy Intake; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods*; D007384:Intermittent Positive-Pressure Breathing / Q000379:methods*; D008297:Male; D008423:Maternal Age; D009666:Nose; D010102:Oxygen Inhalation Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome