Randomized Controlled Trial of Nonsynchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal CPAP after Extubation of VLBW Infants.

BACKGROUND AND OBJECTIVES: Nasal continuous positive airway pressure (NCPAP) is a useful method of respiratory support after extubation. However, some infants fail despite CPAP use and require reintubation. Some evidence suggests that synchronized nasal intermittent positive pressure ventilation (NIPPV) may decrease extubation failure in preterm infants. Nonsynchronized NIPPV (NS-NIPPV) is being widely used in preterm infants without conclusive evidence of its benefits and side effects. Our aim was to evaluate whether NS-NIPPV decreases extubation failure compared with NCPAP in ventilated very low birth weight infants (VLBWI) with respiratory distress syndrome (RDS). METHODS: Randomized controlled trial of ventilated VLBWI being extubated for the first time. Before extubation, infants were randomized to receive NCPAP or NS-NIPPV. Primary outcome was the need for reintubation within 72 h. RESULTS: 220 infants were included. The mean ± SD birth weight was 1,027 ± 256 g and gestational age 27.8 ± 1.9 weeks. Demographic and clinical characteristics were similar in both groups. Extubation failure was 32.4% for NCPAP versus 32.1% for NS-NIPPV, p = 0.98. The frequency of deaths, bronchopulmonary dysplasia, intraventricular hemorrhage, air leaks, necrotizing enterocolitis and duration of respiratory support did not differ between groups. CONCLUSIONS: In this population of VLBWI, NS-NIPPV did not decrease extubation failure after RDS compared with NCPAP.

Restricción del crecimiento extrauterino en recién nacidos de muy bajo peso al nacer internados en el Servicio de Neonatología del Hospital Lagomaggiore, Mendoza, Argentina / EXTRAUTERINE GROWTH RESTRICTION IN VERY LOW BIRTH WEIGHT INFANTS HOSPITALIZED IN NEONATOLOGY SERVICE OF LAGOMAGGIORE HOSPITAL, MENDOZA, ARGENTINA

Introducción: varios estudios sugieren que los recién nacidos prematuros (RNPT), especialmente los nacidos de muy bajo peso al nacer (MBPN), están en mayor riesgo nutricional al momento del alta hospitalaria que al nacer. Materiales y métodos: se correlacionó la frecuencia de restricción del crecimiento extrauterino (RCEU) en recién nacidos de MBPN con variables antropométricas y prácticas alimentarias. Se realizó un estudio longitudinal, retrospectivo y correlacional, evaluando variables antropométricas, prácticas alimentarias, tiempo en recuperar el peso de nacimiento (PN) y tiempo de hospitalización. Se incluyeron 76 RNPT de <1.500 g con peso adecuado para la edad gestacional (PAEG) entre enero de 2013 a diciembre de 2014. Se dividieron en dos grupos: Grupo 1 (G1), N=39 (<1.000 g) y Grupo 2 (G2): N=37 (1.001- 1.500 g). Se utilizó correlación bivariada de Pearson. Resultados: en G1 el puntaje Z del peso al alta hospitalaria se asoció al aumento de peso diario promedio (r=0,725; p=0,01), al tiempo de estadía hospitalaria (r=0,378; p=0,05) y a la presencia de displasia broncopulmonar (DBP) durante la internación (r=0,36; p=0,05). En G2 el puntaje Z del peso al alta se asoció al aumento de peso diario promedio (r=0,656; p=0,01) y a la persistencia del conducto arterioso (DAP) (r=0,406; p=0,05). G1 inició nutrición enteral trófica (NET) más tarde (7,1±6,3 días vs 4,6±3,5 días; p=0,035) y el tiempo necesario para alcanzar la nutrición enteral total fue superior (45,9±16 vs 27,5±12 días; p=0,00). Al alta, el 77% del G1 presentó desnutrición y el 15% riesgo nutricional, mientras que en G2 el 32% estaba desnutrido y el 49% en riesgo nutricional (p=0,00). Conclusiones: el inicio tardío de la NET, el mayor tiempo requerido para alcanzar los requerimientos nutricionales, el PN <1.000 g, la duración de la estadía hospitalaria y la presencia de DBP se asocian al RCEU en RNPT.

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South American very low birth weight infants.

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Prospectively collected data in infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infants survivors were analyzed. Mean birth weight and gestational age were 1085+/-279 g and 29+/-3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. A higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91+/-27 vs. 51+/-19), of mechanical ventilation (19+/-20 vs. 4+/-7) and oxygen therapy (72+/-30 vs. 8+/-14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, airleak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide useful information in the design of effective preventive perinatal strategies.

Bronchopulmonary dysplasia: incidence, risk factors and resource utilization in a population of South-American very low birth weight infants

OBJECTIVE: To determine the incidence of bronchopulmonary dysplasia, its risk factors and resource utilization in a large South American population of very low birth weight infants. METHODS: Data were prospectively collected from infants weighing 500 to 1,500 g born at 16 NEOCOSUR Network centers from 10/2000 through 12/2003. Multivariate relative risk and 95% confidence intervals were estimated by Poisson regression with robust error variance to find factors that affected the risk of bronchopulmonary dysplasia. RESULTS: 1,825 very low birth weight infant survivors were analyzed. Mean birth weight and gestational age were 1085+279 g and 29+3 weeks respectively. Bronchopulmonary dysplasia incidence averaged 24.4% and survival without bronchopulmonary dysplasia augmented with increasing gestational age. Higher birth weight and gestational age and a female gender all decreased the risk for bronchopulmonary dysplasia. Factors that independently increased that risk were surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. Bronchopulmonary dysplasia infants had more days of hospitalization (91±27 vs. 51±19), on mechanical ventilation (19±20 vs. 4±7) and oxygen therapy (72±30 vs. 8±14) in comparison with non BPD infants. CONCLUSIONS: Bronchopulmonary dysplasia incidence was 24.4% in a large South American population and is related to greater resource utilization. Risk factors for bronchopulmonary dysplasia in this study were: surfactant requirement, mechanical ventilation, air leak, patent ductus arteriosus, late onset sepsis and necrotizing enterocolitis. These studies may provide information useful to the design of effective preventive perinatal strategies.