title: N-BiPAP treatment in infants with respiratory distress syndrome: A population study.
abstract: BACKGROUND
  Since November 1st 2008, our Norwegian neonatal intensive care unit has used nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation as first-line treatment after nasal continuous positive airway pressure (n-CPAP) failure in infants with respiratory distress syndrome (RDS).
  
  
  OBJECTIVE
  To assess utility of a national patient register to compare outcomes of infants in our unit before and after November 1st 2008 as well as to hospitals that did not utilize n-BiPAP during the observation period.
  
  
  METHODS
  A retrospective study, using a national patient register and a difference-in-difference (DID) statistical approach, adjusting for confounders.
  
  
  METHODS
  Infants with RDS admitted to hospital 2002-2010.
  
  
  METHODS
  We compared our unit before and after November 1st 2008 and to other hospitals with regards to morbidity, mortality, and number of hospital days (NHD).
  
  
  RESULTS
  Infants with RDS in our unit had a significantly lower risk of bronchopulmonary dysplasia (BPD) (odds ratio (OR) 0.59, p<0.05), retinopathy of prematurity (ROP) (OR 0.57, p<0.05), and intraventricular hemorrhage (IVH) (OR 0.37, p<0.001); as well as the combined outcome of periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), ROP, IVH, and/or BPD (OR 0.53, p<0.05) after November 1st 2008 and compared to other hospitals. PVL, NEC, and mortality did not change. NHD was reduced by 8.
  
  
  CONCLUSIONS
  Increasing use of n-BiPAP was associated with reduced morbidity and NHD in infants with RDS. Using a patient register and DID analyses may be a health economic and ethically sound way of generating hypotheses and knowledge about disease and treatment.
authors.affiliation: The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, 1478 Lørenskog, Norway. Electronic address: a.l.solevag@medisin.uio.no.
authors.forename: Anne Lee
authors.initials: AL
authors.lastname: Solevåg
authors.affiliation: The Health Services Research Centre HØKH, Akershus University Hospital, 1478 Lørenskog, Norway.
authors.forename: Inger Cathrine
authors.initials: IC
authors.lastname: Kann
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D045422:Continuous Positive Airway Pressure; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Morbidity; Mortality; Nasal biphasic positive airway pressure; Newborn; Respiratory distress syndrome