title: Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations.
abstract: BACKGROUND
  Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage.
  
  
  OBJECTIVE
  To determine if introduction of bubble nasal CPAP (bnCPAP), early surfactant treatment, and rapid extubation (combined bnCPAP strategy) in our community-based neonatal ICU reduced bronchopulmonary dysplasia (BPD).
  
  
  METHODS
  This was a 7-year retrospective,single-institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model.
  
  
  RESULTS
  The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4% (P = .02), reaching a minimum in the last post-bnCPAP year of22.1% (P = .02). When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD(P = .003, odds ratio 0.43, 95% CI 0.25– 0.75). Decreases occurred in mechanical ventilation and the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely-low-birth-weight newborns, improved respiratory outcomes in the post-bnCPAP years,as compared to outcomes in the pre-bnCPAP years, included an increase in the percentage alive and off mechanical ventilation at 1 week postnatal age (P < .001), a more rapid extubation rate(P < .03), a decrease in the median days on mechanical ventilation (P = .002), and a decrease in the percentage with BPD plus died (P = .01). Post-bnCPAP extremely-low-birth-weight babies had a statistically significant decrease in retinopathy of prematurity, an increase in low-grade intraventricular hemorrhage, and a decrease in ductal ligations.
  
  
  CONCLUSIONS
  A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.
authors.affiliation: Division of Neonatology, Memorial Hermann Southwest Hospital, Houston, TX, USA. charlesfriedman@comcast.net
authors.forename: Charles A
authors.initials: CA
authors.lastname: Friedman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Menchaca
authors.forename: Mary C
authors.initials: MC
authors.lastname: Baker
authors.forename: Clarissa K
authors.initials: CK
authors.lastname: Rivas
authors.forename: Raymond N
authors.initials: RN
authors.lastname: Laberge
authors.forename: Enrique H
authors.initials: EH
authors.lastname: Rios
authors.forename: Syed H
authors.initials: SH
authors.lastname: Haider
authors.forename: Edgar J
authors.initials: EJ
authors.lastname: Romero
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Eason
authors.forename: J Kennard
authors.initials: JK
authors.lastname: Fraley
authors.forename: Mesfin
authors.initials: M
authors.lastname: Woldesenbet
mesh_terms: D060666:Airway Extubation / Q000379:methods / Q000706:statistics & numerical data; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants