title: Nasal continuous positive airway pressure therapy in a non-tertiary neonatal unit: reduced need for up-transfers.
abstract: OBJECTIVE
  To evaluate the need for up-transfer after starting of nasal continuous positive airway pressure (n-CPAP) services in a Level II special newborn care unit (SNCU).
  
  
  METHODS
  Five hundred fifty infants admitted to Level II SNCU, 252 infants during one year prior to introduction of n-CPAP (retrospective data from case records and electronic data base) and 298 infants during one year after introduction of n-CPAP services (prospective data in predefined case reporting form) were evaluated in this before and after intervention trial. The primary outcome was proportion of infants needing up-transfers from Level II SNCU for any indication.
  
  
  RESULTS
  Baseline demographic data like birth weight, gestation and other perinatal factors were similar between the two epochs. Among the infants admitted to Level II SNCU, up-transfer for any reason was significantly higher in the pre-CPAP epoch compared with CPAP epoch (n = 93, 36 % vs. n = 74, 24.8 %, p = 0.002, OR 0.56, 95 % CI 0.38 to 0.83). However parent desired up-transfers were similar between the two epochs (n = 9, 3 % vs. n = 16, 5 %, p = 0.40). Introduction of n-CPAP treatment modality reduced up-transfers in subgroups of very low birth weight infants (VLBW) (n = 20, 74 % vs. n = 15, 37 %, p = 0.003) and also in preterm infants (n = 50, 54 % vs. n = 34, 32 %, p = 0.002).
  
  
  CONCLUSIONS
  Introduction of n-CPAP services in a non-tertiary care neonatal unit, significantly reduced the need for up-transfers, especially in VLBW and preterm infants.
authors.affiliation: Department of Pediatrics, Fernandez Hospital, Hyderabad, Andhra Pradesh, 500029, India.
authors.forename: Sai
authors.initials: S
authors.lastname: Kiran
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murki
authors.forename: Oleti Tejo
authors.initials: OT
authors.lastname: Pratap
authors.forename: Hemasree
authors.initials: H
authors.lastname: Kandraju
authors.forename: Anupama
authors.initials: A
authors.lastname: Reddy
mesh_terms: D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data; D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D020380:Needs Assessment; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000628:therapy