1798 Clinical Outcomes of Very-Low-Birth-Weight Infants who Receive Non-Invasive Ventilatory Support

Abstract

Objective: To evaluate the clinical outcomes of very-low-birth-weight infants who receive non-invasive ventilation at delivery room (DR) and NICU. Design: The study was designed prospectively from January-2009 for three years. Infants born before 28 weeks and infants born at 29 to 30 weeks who didn't receive antenatal steroid (ANS) were included. During resuscitation, stabilisation and transport infants were ventilated with a T-piece resuscitator (NeoPuff). All received 100 mg/kg surfactant. If respiratory drive was present, infants were extubated to nasal CPAP (NCPAP) through short binasal prong (Infant Flow). Any infant who needed FiO2 > 0.4 on NCPAP to maintain an oxygen saturation at 88-92% with clinical deterioration or who had respiratory acidosis defined as pCO2 > 65mmHg and pH< 7.2 on arterial blood gas sample was intubated and mechanical ventilation (MV) was initiated. The need for MV within the first 3 days of life, neonatal morbidities, mortality, and duration of hospitalisation were assessed. Results: Eighty infants met the inclusion criteria during the study period. The mean gestational age (GA) and the mean birth weight (BW) of infants were 27.0+/-2.1 weeks, and 936.5+/-299.1 g, respectively. Half of them were male, 74% of infants were born by C/S, 55% of infants were born from multiple pregnancies. ANS was given to 27.5% of the pregnancies. The presence of premature rupture of membranes and chorioamnionitis were 57.5% and 34%, respectively. Twenty-three (28.7%) infants could not be extubated at the DR, where 53 (71.3%) infants received NCPAP. Mean GA and BW were statistically lower in the infants who couldn't be extubated (p < 0.001). Ten (17.5%) of 53 infants who were on NCPAP initially needed MV during their first 3 days. There wasn't any case with air leak. The incidence of pulmonary haemorrhage, PDA, NEC, IVH, BPD, ROP and mortality were 6.2%, 30%, 20%, 14%, 10%, 9% and 38.7%, respectively. The duration of respiratory support was 1-720 hours (median: 29 hours). Mean duration of hospitalisation was 34.9+/-28.4 days. Mean GA and BW were lower, the incidence of pulmonary haemorrhage, IVH, BPD and mortality were higher in infants who failed NCPAP than infants who never intubated (p < 0.05). Conclusion: Our study demonstrated that NCPAP is an effective noninvasive ventilatory strategy. It didn't increase the risk of air leak. The incidences of BPD and ROP in our series were lower than reported in 'NICHD Neonatal Research Network' data (10% vs 27%, and 9% vs 12%).