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Massa-Buck B, Rastogi D, Rastogi S. Complications associated with incorrect use of nasal CPAP. J Perinatol 2023; 43:975-981. [PMID: 37231122 DOI: 10.1038/s41372-023-01700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use. This is a comprehensive review that seeks to address the different complications that are associated with the incorrect use of nCPAP highlighting that these are operator-related and not device-related.
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Affiliation(s)
- Beri Massa-Buck
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA
| | - Deepa Rastogi
- Division of Pediatric Pulmonology, Children's National Hospital, Washington DC, USA
| | - Shantanu Rastogi
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA.
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Xie F, Shu Q, Chen ZY, Li J. Length of stay and influencing factors of NICU in the Western Hunan, an underdeveloped area of China: A 9-year retrospective study. J Int Med Res 2022; 50:3000605221100753. [PMID: 35748018 PMCID: PMC9247289 DOI: 10.1177/03000605221100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the factors that influence the length of stay (LOS) in a
neonatal intensive care unit (NICU). Methods This retrospective study analysed clinical data from all newborns
hospitalized in the NICU of a tertiary hospital in the Western Hunan area of
China over a 9-year period (2012–2020). Factors associated with the LOS were
analysed using univariate analysis and Cox regression analysis. Results A total of 16 094 newborns were included in the study: of which 9615 were
inborn and 6479 were outborn newborns. There were 9482 males and 6612
females. Over the 9-year period, the mean LOS was 11.08 days (median LOS,
9.00 days; range, 1–141 days); and the LOS first increased, then decreased
and stabilized. A LOS of 8–28 days was the most common duration (8849 of 16
094; 54.98%). Cox regression analysis demonstrated that sex, patient source,
delivery method, gestational age, birth weight and comorbidities were
significantly associated with LOS. Conclusion Being male, low gestational age and low birth weight increased the LOS.
Reducing preterm and post-term infants, as well as eliminating
comorbidities, could effectively shorten the LOS of newborns.
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Affiliation(s)
- Fen Xie
- Department of Nursing, Jishou University School of Medicine, Jishou, Hunan Province, China.,Department of Neonatology, The Fourth Affiliated Hospital of Jishou University (The First People's Hospital of Huaihua), Huaihua, Hunan Province, China
| | - Qingxia Shu
- Department of Nursing, Jishou University School of Medicine, Jishou, Hunan Province, China.,Department of Neonatology, The Fourth Affiliated Hospital of Jishou University (The First People's Hospital of Huaihua), Huaihua, Hunan Province, China
| | - Zheng-Ying Chen
- Department of Nursing, Jishou University School of Medicine, Jishou, Hunan Province, China
| | - Jinxiu Li
- Department of Nursing, Jishou University School of Medicine, Jishou, Hunan Province, China
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Lapcharoensap W, Bennett MV, Powers RJ, Finer NN, Halamek LP, Gould JB, Sharek PJ, Lee HC. Effects of delivery room quality improvement on premature infant outcomes. J Perinatol 2017; 37:349-354. [PMID: 28005062 DOI: 10.1038/jp.2016.237] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/21/2016] [Accepted: 11/14/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Delivery room management interventions have been successfully implemented via collaborative quality improvement (QI) projects. However, it is unknown whether these successes translate to reductions in neonatal morbidity and mortality. STUDY DESIGN This was a prospective pre-post intervention study of three nonrandomized hospital groups within the California Perinatal Quality Care Collaborative. A collaborative QI model (Collaborative QI) was compared with a single-site QI model (NICU QI) and a non-participant population when implementing evidence-based delivery room practices. The intervention period was between June 2011 and May 2012. Infants born with gestational age between 22 weeks 0 days and 29 weeks 6 days and birth weight ⩽1500 g were included. Outcomes were mortality and select morbidities (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC)). Outcomes were compared between the baseline (January 2010 to May 2011) and post-intervention period (June 2012 to May 2013) within each comparison group. RESULTS Ninety-five hospitals were included with 4222 infants in the baseline period and 4186 infants in the post-intervention period. The Collaborative QI group had significantly reduced odds of developing BPD post-intervention (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.65 to 0.99) or composite BPD-death (OR 0.83, 95% CI 0.69 to 1.00). In both the Collaborative QI and non-participants there were also reductions in IVH, severe IVH, composite severe IVH-death, severe ROP and composite severe ROP-death. CONCLUSION Hospitals dedicated to improving delivery room practices can impact neonatal outcomes.
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Affiliation(s)
- W Lapcharoensap
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - M V Bennett
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - R J Powers
- Pediatrix Medical Group, San Jose, CA, USA
| | - N N Finer
- University of California San Diego, San Diego, CA, USA
| | - L P Halamek
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,Center for Advanced Pediatric and Perinatal Education, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - J B Gould
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - P J Sharek
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - H C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev 2011; 12:196-205. [PMID: 21722849 DOI: 10.1016/j.prrv.2010.12.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/02/2010] [Accepted: 12/19/2010] [Indexed: 01/09/2023]
Abstract
Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia, sepsis, and trauma to the upper airways. In the last 4 decades, nasal continuous positive airway pressure (CPAP) has been used to wean preterm infants off mechanical ventilation and, more recently, as a primary mode of respiratory support for preterm infants with respiratory insufficiency. Moreover, new methods of respiratory support have been developed, and the devices used to provide non-invasive ventilation (NIV) have improved technically. Use of NIV is increasing, and a variety of equipment is available in different clinical settings. There is evidence that NIV improves gas exchange and reduces extubation failure after mechanical ventilation in infants. However, more research is needed to identify the most suitable devices for particular conditions; the NIV settings that should be used; and whether to employ synchronized or non-synchronized NIV. Furthermore, the optimal treatment strategy and the best time for initiation of NIV remain to be identified. This article provides an overview of the use of non-invasive ventilation (NIV) in newborn infants, and the clinical applications of NIV.
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Affiliation(s)
- Ramadan A Mahmoud
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
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Aly H, Massaro AN, Hammad TA, Narang S, Essers J. Early nasal continuous positive airway pressure and necrotizing enterocolitis in preterm infants. Pediatrics 2009; 124:205-10. [PMID: 19564301 DOI: 10.1542/peds.2008-2588] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of early nasal continuous positive airway pressure (ENCPAP) as the mode of initial respiratory support for very low birth weight (VLBW) infants has been increasing. The impact of CPAP and oxygen on gut mucosa and perfusion in premature infants is not known. The relation between ENCPAP and necrotizing enterocolitis (NEC) has not been adequately addressed. OBJECTIVE To evaluate if the use of an individualized respiratory management strategy encouraging the use of ENCPAP is associated with an increased risk of NEC, and to determine risk factors for NEC in premature infants supported by CPAP. METHODS A retrospective analysis was conducted on VLBW infants (birth weight < 1500 g) managed at 2 institutions that use an ENCPAP respiratory management strategy for premature infants. Data on the use of oxygen and mode of ventilatory support were collected during the first 3 days of life. Diagnosis of NEC was used as the dependent variable in a logistic regression model. Birth weight, gender, prenatal steroid use, mode of respiratory support (CPAP versus ventilator) and fraction of inspired oxygen, umbilical artery catheter placement, partial pressure of oxygen, patent ductus arteriosus, early sepsis, hospital, and delivery room management (ENCPAP versus initial intubation) were controlled for in the model. RESULTS Data on 343 premature infants were collected for this study. Mean birth weight was 999 +/- 289 g and gestational age was 28 +/- 2.6 weeks. The majority of patients were managed with ENCPAP, with only 13% of patients intubated in the delivery room. The overall incidence of NEC was 7% (n = 24). The exposure to ENCPAP did not increase the risk for NEC compared with the use of a ventilator. CONCLUSIONS. The risk of NEC in VLBW premature infants was not increased by the use of ENCPAP. Initial respiratory support with ENCPAP seems to be a safe alternative to routine intubation and mechanical ventilation in premature infants.
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Affiliation(s)
- Hany Aly
- Department of Neonatology, Children's National Medical Center, Washington, DC 20037, USA.
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Abstract
PURPOSE OF REVIEW To present recent data on the role of noninvasive ventilation in the respiratory management of newborn infants. RECENT FINDINGS Noninvasive ventilation is growing in popularity but is applied using widely varying devices and settings. Although short-term physiological advantages were reported for bubble and variable-flow continuous positive airways pressure, neither has convincingly shown superior clinically important outcomes. Continuous positive airways pressure may be used as the initial mode of support for very preterm infants but increased rates of pneumothorax in infants not receiving surfactant are a concern. Methods of administering surfactant without endotracheal intubation deserve further study. Nasal intermittent positive-pressure ventilation shows promise as a primary treatment for respiratory distress syndrome. Optimal pressure settings for continuous positive airways pressure and nasal intermittent positive-pressure ventilation remain uncertain. SUMMARY Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.
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te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room respiratory management in very preterm infants. Pediatrics 2007; 120:322-9. [PMID: 17671058 DOI: 10.1542/peds.2007-0114] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Initial ventilation strategy may play an important role in the development of bronchopulmonary dysplasia in very preterm infants. Early nasal continuous positive airway pressure is an accepted approach, but randomized clinical trials are lacking. Our aim was to determine whether early nasal continuous positive airway pressure, preceded by a sustained inflation, is more effective and less injurious in very preterm infants than conventional intervention. METHODS Two hundred seven very preterm infants were assigned randomly in the delivery room to either a sustained inflation through a nasopharyngeal tube followed by early nasal continuous positive airway pressure (early functional residual capacity intervention) or repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure, if necessary, after arrival at the NICU. The primary outcome measure was intubation <72 hours of age and bronchopulmonary dysplasia at 36 weeks was used as secondary outcome. This trial was registered as an early functional residual capacity intervention trial (ISRCTN 12757724). RESULTS In the early functional residual capacity intervention group, fewer infants were intubated at <72 hours of age or received >1 dose of surfactant, and the average duration of ventilatory support was less. Infants in the early functional residual capacity intervention group developed bronchopulmonary dysplasia less frequently. CONCLUSIONS A sustained inflation followed by early nasal continuous positive airway pressure, delivered through a nasopharyngeal tube, is a more efficient strategy than repeated manual inflations with a self-inflating bag and mask followed by nasal continuous positive airway pressure on admission to the NICU.
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Affiliation(s)
- Arjan B te Pas
- Department of Pediatrics, Leiden University Medical Center, J6-S, Box 9600, 2300 RC Leiden, The Netherlands.
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Aly H. Is there a strategy for preventing bronchopulmonary dysplasia? Absence of evidence is not evidence of absence. Pediatrics 2007; 119:818-20. [PMID: 17403854 DOI: 10.1542/peds.2006-3026] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hany Aly
- Department of Newborn Services, George Washington University and Children's National Medical Center, Washington, DC, USA.
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