title: The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institution.
abstract: OBJECTIVE
  Nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) with the option of back-up ventilation for those infants for whom noninvasive ventilatory support failed resulted in a significant increase in survival in extremely low birth weight (ELBW) infants. The authors sought to determine the outcome of ELBW infants treated with NCPAP and InSurE in a neonatal high care ward with limited back-up ventilation.
  
  
  METHODS
  Three hundred eighteen inborn infants with birth weight 500-1000 g and gestational age ≥25 weeks who were admitted to the neonatal high care ward were included in this observational study. InSurE was administered to infants with respiratory distress syndrome on NCPAP who had severe in-drawing and recession, apneic spells, or an Fio(2) >0.4 within 1 hour of birth.
  
  
  RESULTS
  Two hundred twelve (68.6%) infants could be treated with NCPAP only and 97 (31.4%) required InSurE. Seventeen infants were admitted to the NICU; 90%, 87%, and 74.8% of the infants survived until day 3, 7, and discharge, respectively. Only 2 infants developed a pneumothorax and 2 had chronic lung disease. Seventy-nine percent of the infants of ≥750 g or >26 weeks' gestation survived to discharge compared with 56% and 60% of the infants of <750 g or ≤26 weeks' gestation, respectively. Maternal antenatal steroid administration contributed significantly to the survival of the infants (P = 0.0017, odds ratio 2.7, 95% confidence interval 1.44-5.07).
  
  
  CONCLUSIONS
  The use of NCPAP and InSurE in a neonatal high care ward with limited resources can improve the survival of ELBW infants. Maternal antenatal steroid administration contributed significantly to survival.
authors.affiliation: Division of Neonatology, Tygerberg Children’s Hospital, Western Cape, South Africa. gfk@sun.ac.za
authors.forename: Gerhardus Francois
authors.initials: GF
authors.lastname: Kirsten
authors.forename: Cheryl Linda
authors.initials: CL
authors.lastname: Kirsten
authors.forename: Philippus Arnold
authors.initials: PA
authors.lastname: Henning
authors.forename: Johan
authors.initials: J
authors.lastname: Smith
authors.forename: Sandi Lee
authors.initials: SL
authors.lastname: Holgate
authors.forename: Adrie
authors.initials: A
authors.lastname: Bekker
authors.forename: Gugulabatembunamahlubi Tenjiwe Jabulile
authors.initials: GT
authors.lastname: Kali
authors.forename: Justin
authors.initials: J
authors.lastname: Harvey
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000600:supply & distribution*; D007442:Intubation, Intratracheal; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome