Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country
| Autor: | Siew-Hong Neoh, Nem-Yun Boo, Irene Guat-Sim Cheah, Seok-Chiong Chee |
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| Rok vydání: | 2015 |
| Předmět: |
Male
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty medicine.medical_treatment education Developing country 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Intensive Care Units Neonatal mental disorders Infant Mortality medicine Humans Infant Very Low Birth Weight 030212 general & internal medicine Continuous positive airway pressure Developing Countries reproductive and urinary physiology Bronchopulmonary Dysplasia Retrospective Studies Extremely premature Respiratory Distress Syndrome Newborn Continuous Positive Airway Pressure business.industry Obstetrics Delivery Rooms Infant Newborn Malaysia Infant Retrospective cohort study respiratory system Length of Stay medicine.disease Infant mortality Low birth weight Logistic Models Bronchopulmonary dysplasia Infant Extremely Premature Pediatrics Perinatology and Child Health Female medicine.symptom RESPIRATORY DISTRESS SYNDROME NEWBORN business Developmental Biology |
| Zdroj: | Neonatology. 110(2) |
| ISSN: | 1661-7819 |
| Popis: | Background: Early nasal continuous positive airway pressure (EnCPAP) therapy after birth for very low birth weight (VLBW; Objectives: This study aimed to determine EnCPAP rates in 36 neonatal intensive care units of the Malaysian National Neonatal Registry (MNNR) in 2013, to compare the outcomes of VLBW neonates with and without EnCPAP, and to determine whether the availability of CPAP facilities and unit policies played a significant role in EnCPAP rates. Methods: First, a retrospective cohort study was conducted of VLBW neonates born in the hospitals participating in the study without major congenital abnormalities in the MNNR. This was followed by a questionnaire survey of these hospitals focussed on CPAP facilities and unit policies. Results: Of the 2,823 neonates, 963 (34.1%) received EnCPAP. Amongst EnCPAP neonates significantly fewer deaths were recorded (10.9 vs. 21.7%; p < 0.001), less bronchopulmonary dysplasia was observed (BPD; 8.0 vs. 11.7%; p = 0.002) and fewer mechanical ventilation days were necessary (p < 0.001) than in non-EnCPAP neonates. Logistic regression analysis showed that EnCPAP was significantly associated with a lower mortality (adjusted OR 0.623; 95% CI 0.472, 0.824; p = 0.001) and BPD among survivors (adjusted OR 0.585; 95% CI 0.427, 0.802; p = 0.001). The median EnCPAP rate of the 36 hospitals was 28.4% (IQR 14.3-38.7). Hospitals with CPAP facilities in the delivery suites (p = 0.001) and during transport (p = 0.001) and a policy for EnCPAP (p = 0.036) had significantly higher EnCPAP rates. Conclusion: EnCPAP reduced mortality and BPD in Malaysian VLBW neonates. Resource-strapped developing countries should prioritise the use of this low-cost therapy. |
| Databáze: | OpenAIRE |
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