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Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study.

Rezzonico R, Caccamo LM, Manfredini V, Cartabia M, Sanchez N, Paredes Z, Froesch P, Cavalli F, Bonati M - BMC Pediatr (2015)

Bottom Line: Secondary endpoints included rate of intubation and duration of NICU stay.Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001).Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481).

View Article: PubMed Central - PubMed

Affiliation: NICU Rho Az. Ospedaliera "G. Salvini" Garbagnate Milanese, Milan, Italy. rossano.rezzonico@libero.it.

ABSTRACT

Background: The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.

Objective: To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.

Design: Prospective pre-intervention and post-intervention study.

Setting: The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.

Participants: In all, 230 (2006) and 383 (2008) patients were included.

Intervention: In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.

Outcome measures: The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.

Results: Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481). The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.

Conclusions: This is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.

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Related in: MedlinePlus

Distribution by ventilation type and related deaths (striped).
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Fig3: Distribution by ventilation type and related deaths (striped).

Mentions: In 2008 the number of VA patients admitted to the NICU increased by 67%, but mortality decreased significantly, from 40.4% (n = 93) in 2006 to 22.7% (n = 87) (p < 0.0001). In ETT newborns, the mortality rate remained unchanged, from 53.0% to 53.3% (p = ns) (Figure 3). If only the MV patient group was considered, however, mortality increased from 52% in 2006 to 90% in 2008 (p < 0.0001) (Table 3).Figure 3


Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study.

Rezzonico R, Caccamo LM, Manfredini V, Cartabia M, Sanchez N, Paredes Z, Froesch P, Cavalli F, Bonati M - BMC Pediatr (2015)

Distribution by ventilation type and related deaths (striped).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4376103&req=5

Fig3: Distribution by ventilation type and related deaths (striped).
Mentions: In 2008 the number of VA patients admitted to the NICU increased by 67%, but mortality decreased significantly, from 40.4% (n = 93) in 2006 to 22.7% (n = 87) (p < 0.0001). In ETT newborns, the mortality rate remained unchanged, from 53.0% to 53.3% (p = ns) (Figure 3). If only the MV patient group was considered, however, mortality increased from 52% in 2006 to 90% in 2008 (p < 0.0001) (Table 3).Figure 3

Bottom Line: Secondary endpoints included rate of intubation and duration of NICU stay.Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001).Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481).

View Article: PubMed Central - PubMed

Affiliation: NICU Rho Az. Ospedaliera "G. Salvini" Garbagnate Milanese, Milan, Italy. rossano.rezzonico@libero.it.

ABSTRACT

Background: The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.

Objective: To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.

Design: Prospective pre-intervention and post-intervention study.

Setting: The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.

Participants: In all, 230 (2006) and 383 (2008) patients were included.

Intervention: In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.

Outcome measures: The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.

Results: Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481). The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.

Conclusions: This is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.

Show MeSH
Related in: MedlinePlus