Better practices may yield better respiratory outcomes in preterm infants

Levesque B. Pediatrics. 2011;doi:10.1542/peds.2010-3265.

Intubation decreased approximately 30% after the implementation of five potentially better practices to limit mechanical ventilation and other respiratory outcomes in a cohort of preterm infants, according to study results.

Eligible infants were born before 33 weeks’ gestation. The aim of the trial was to determine the effect of the practices on mechanical ventilation, supplemental oxygen and bronchopulmonary dysplasia in 61 infants born before the program was implemented and 60 infants born after implementation.

The five methods evaluated were:

Exclusive use of bubble continuous positive airway pressure (bCPAP).
Provision of bCPAP in the delivery room.
Strict intubation criteria.
Strict extubation criteria.
Prolonged CPAP to avoid supplemental oxygen.

Among infants born 26 to just before 33 weeks’ gestation, intubation in the first 72 hours decreased from 52% to 11% (P<.0001) and surfactant use decreased from 48% to 14% (P=.0001), according to the results.

The mean plus/minus standard deviation (SD) fraction of inspired oxygen requirement in the first 24 hours decreased from 0.27 ± 0.08 to 0.24 ± 0.05 (P=.0005) in the entire cohort. All infants also experienced a decrease in mean plus/minus SD fraction in days of oxygen (23.5 ± 44.5 to 9.3 ± 22; P=.04) and days of mechanical ventilation (8.8 ± 27.8 to 2.2 ± 6.2; P=.005).

A decrease in hypotension from 33% to 15% (P=.03) was also observed. Before implementation, the percentage of infants with bronchopulmonary dysplasia was 17% vs. 8% after implementation (P=.27).

The researchers said nurse staffing ratios did not change.

Outborn infants and infants with major anomalies and obstetric complications were excluded from the analysis.

“The biggest impact was on measures of respiratory care and a reduction in treated hypotension,” the researchers wrote. “Overall, non-personnel cost-of-care and nurse staffing ratios were unchanged, but equipment costs and the cost of surfactant were lower.”

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