Early Cpap Use and Its Impact on Vlbw Outcomes

Abstract

Background: Recent RCTs have shown that CPAP is safe & feasible for preventing routine intubation in delivery room & shortens the duration of intubation after extubation. However, it also increases risk of airleaks. Objective: To determine the trends in early CPAP use & its impact on outcomes of VLBW babies admitted to Canadian NICUs. Design/Methods: A retrospective study of VLBW infants was done in participating CNN NICUs between 2003 & 2008. Yearly data on demography, interventions (CPAP, IMV, HFV, indomethacin, surfactant, pressors, antenatal & postnatal steroids) & outcomes untill discharge were extracted from CNN database. The proportion of infants using CPAP on day 1 & 3 were used as indicators of early CPAP use. Trends in CPAP use over time & its relationship with outcomes were analyzed. Results: There were 12,056 infants. The median gestational age, birth weight & SNAP scores were 28w, 1065g & 9 respectively. 51%, 78% and 62% of infants were males, inborn and delivered by C section. The proportion of infants receiving early CPAP & antenatal steroids increased and pressors reduced significantly overtime. Other interventions & demography did not change. The incidence of BPD or pneumothorax did not change, but nosocomial infection (NI), ventricular enlargement/parenchymal echodensities and ROP reduced overtime. With increased use of CPAP on D3, there was significant reduction in NI (p=0.008, r=0.97) & ROP (p=0.02, r=0.93). A trend towards lower mortality (p=0.06, r=0.85), BPD at 28d (p=0.06, r=0.86), & BPD at 36w (p=0.06, r=0.87) was also observed [Table][Figure]. (Figure presented) Conclusions: Early CPAP may be associated with improved outcomes in VLBW.