Changes in respiratory support of preterm infants in the last decade: are we improving?
BACKGROUND
Ventilator-induced lung injury has been recognized as a major contributing factor for bronchopulmonary dysplasia (BPD) in preterm infants. In the last decade, focus has shifted towards a more gentle respiratory approach.


OBJECTIVE
To evaluate whether guideline changes in respiratory management in the delivery room and the unit improved the incidence of BPD in very preterm infants.


METHODS
Three cohorts of infants <30 weeks of gestation, born at the Leiden University Medical Center in the Netherlands in 1996-1997 (cohort '96), 2003-2004 (cohort '03) and 2008-2009 (cohort '08), were compared retrospectively. The major change was increasing use of continuous positive airway pressure in time, and monitoring the tidal volume during mechanical ventilation in cohort '08. The primary outcome was BPD at 36 weeks.


RESULTS
The incidence of BPD did not change from 47% in cohort '96 to 55% in cohort '03 (n.s.), but decreased significantly to 37% in cohort '08 (cohort '96 vs. '08 and cohort '03 vs. '08: p < 0.01). We observed the same effect when only moderate and severe BPD were counted with 27% in cohort '96, 31% in cohort '03 and 14% in '08 (cohort '96 vs. '03: p = n.s., cohort '96 vs. '08: p < 0.01, cohort '03 vs. '08: p < 0.05). The mortality rate was not significantly different between the three cohorts.


CONCLUSIONS
The incidence of BPD in our cohort of preterm infants has decreased during the last decade and could be due to the changes in respiratory management.
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
E E M
EE
Mulder
E
E
Lopriore
M
M
Rijken
F J
FJ
Walther
A B
AB
te Pas
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D058996:Quality Improvement / Q000639:trends; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000592:standards / Q000639:trends*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D055397:Ventilator-Induced Lung Injury / Q000151:congenital / Q000453:epidemiology