Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration

A historical cohort study

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

OBJECTIVE. The goal was to investigate the clinical impact of 3 early management practice changes for infants of ≤1000 g. METHODS.We performed an historical cohort study of appropriately sized, preterm infants without congenital anomalies who were born between January 2001 and June 2002 (pre-early management practice change group; n = 87) and between July 2004 and December 2005 (post-early management practice change group; n = 76). RESULTS. Only 1 (1%) of 87 infants in the pre-early management practice change group received continuous positive airway pressure treatment in the first 24 hours of life, compared with 61 (80%) of 76 infants in the post-early management practice change group. The proportions of infants who required any synchronized intermittent mandatory ventilation during their hospital stays were 98.8% and 59.5%, respectively. The mean durations of synchronized intermittent mandatory ventilation were 35 days and 15 days, respectively. The combined incidence rates of moderate and severe bronchopulmonary dysplasia at corrected gestational age of 36 weeks were 43% and 24%, respectively. The use of vasopressor support for hypotension in the first 24 hours of life decreased from 39.1% (before early management practice changes) to 19.7% (after practice changes), the cumulative days of oxygen therapy decreased from 77 ± 52 days to 56 ± 47 days, and the proportions of infants discharged with home oxygen therapy decreased from 25.7% to 10.1%; the incidence of patent ductus arteriosus requiring surgical ligation increased from 1% to 10%.There were no differences in rates of death, intraventricular hemorrhage, periventricular leukomalacia, pneumothorax, necrotizing enterocolitis, or retinopathy of prematurity. CONCLUSIONS. Successful early management of extremely preterm infants with surfactant treatment followed by continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid supplementation is possible and is associated with reductions in the incidence and severity of bronchopulmonary dysplasia.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalPediatrics
Volume121
Issue number1
DOIs
StatePublished - Jan 2008

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Bronchopulmonary Dysplasia
Continuous Positive Airway Pressure
Practice Management
Surface-Active Agents
Cohort Studies
Oxygen
Amino Acids
Incidence
Ventilation
Therapeutics
Extremely Premature Infants
Periventricular Leukomalacia
Retinopathy of Prematurity
Necrotizing Enterocolitis
Patent Ductus Arteriosus
Pneumothorax
Premature Infants
Hypotension
Gestational Age
Ligation

Keywords

  • Bronchopulmonary dysplasia
  • Continuous positive airway pressure
  • Early amino acids
  • Extremely low birth weight neonates
  • Oxygen saturation
  • Patent ductus arteriosus
  • Prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{ae0f3e3c1cfe460db17fdc893ca7b3c9,
title = "Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration: A historical cohort study",
abstract = "OBJECTIVE. The goal was to investigate the clinical impact of 3 early management practice changes for infants of ≤1000 g. METHODS.We performed an historical cohort study of appropriately sized, preterm infants without congenital anomalies who were born between January 2001 and June 2002 (pre-early management practice change group; n = 87) and between July 2004 and December 2005 (post-early management practice change group; n = 76). RESULTS. Only 1 (1{\%}) of 87 infants in the pre-early management practice change group received continuous positive airway pressure treatment in the first 24 hours of life, compared with 61 (80{\%}) of 76 infants in the post-early management practice change group. The proportions of infants who required any synchronized intermittent mandatory ventilation during their hospital stays were 98.8{\%} and 59.5{\%}, respectively. The mean durations of synchronized intermittent mandatory ventilation were 35 days and 15 days, respectively. The combined incidence rates of moderate and severe bronchopulmonary dysplasia at corrected gestational age of 36 weeks were 43{\%} and 24{\%}, respectively. The use of vasopressor support for hypotension in the first 24 hours of life decreased from 39.1{\%} (before early management practice changes) to 19.7{\%} (after practice changes), the cumulative days of oxygen therapy decreased from 77 ± 52 days to 56 ± 47 days, and the proportions of infants discharged with home oxygen therapy decreased from 25.7{\%} to 10.1{\%}; the incidence of patent ductus arteriosus requiring surgical ligation increased from 1{\%} to 10{\%}.There were no differences in rates of death, intraventricular hemorrhage, periventricular leukomalacia, pneumothorax, necrotizing enterocolitis, or retinopathy of prematurity. CONCLUSIONS. Successful early management of extremely preterm infants with surfactant treatment followed by continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid supplementation is possible and is associated with reductions in the incidence and severity of bronchopulmonary dysplasia.",
keywords = "Bronchopulmonary dysplasia, Continuous positive airway pressure, Early amino acids, Extremely low birth weight neonates, Oxygen saturation, Patent ductus arteriosus, Prematurity",
author = "Cara Geary and Melinda Caskey and Rafael Fonseca and Michael Malloy",
year = "2008",
month = "1",
doi = "10.1542/peds.2007-0225",
language = "English (US)",
volume = "121",
pages = "89--96",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "1",

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TY - JOUR

T1 - Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration

T2 - A historical cohort study

AU - Geary, Cara

AU - Caskey, Melinda

AU - Fonseca, Rafael

AU - Malloy, Michael

PY - 2008/1

Y1 - 2008/1

N2 - OBJECTIVE. The goal was to investigate the clinical impact of 3 early management practice changes for infants of ≤1000 g. METHODS.We performed an historical cohort study of appropriately sized, preterm infants without congenital anomalies who were born between January 2001 and June 2002 (pre-early management practice change group; n = 87) and between July 2004 and December 2005 (post-early management practice change group; n = 76). RESULTS. Only 1 (1%) of 87 infants in the pre-early management practice change group received continuous positive airway pressure treatment in the first 24 hours of life, compared with 61 (80%) of 76 infants in the post-early management practice change group. The proportions of infants who required any synchronized intermittent mandatory ventilation during their hospital stays were 98.8% and 59.5%, respectively. The mean durations of synchronized intermittent mandatory ventilation were 35 days and 15 days, respectively. The combined incidence rates of moderate and severe bronchopulmonary dysplasia at corrected gestational age of 36 weeks were 43% and 24%, respectively. The use of vasopressor support for hypotension in the first 24 hours of life decreased from 39.1% (before early management practice changes) to 19.7% (after practice changes), the cumulative days of oxygen therapy decreased from 77 ± 52 days to 56 ± 47 days, and the proportions of infants discharged with home oxygen therapy decreased from 25.7% to 10.1%; the incidence of patent ductus arteriosus requiring surgical ligation increased from 1% to 10%.There were no differences in rates of death, intraventricular hemorrhage, periventricular leukomalacia, pneumothorax, necrotizing enterocolitis, or retinopathy of prematurity. CONCLUSIONS. Successful early management of extremely preterm infants with surfactant treatment followed by continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid supplementation is possible and is associated with reductions in the incidence and severity of bronchopulmonary dysplasia.

AB - OBJECTIVE. The goal was to investigate the clinical impact of 3 early management practice changes for infants of ≤1000 g. METHODS.We performed an historical cohort study of appropriately sized, preterm infants without congenital anomalies who were born between January 2001 and June 2002 (pre-early management practice change group; n = 87) and between July 2004 and December 2005 (post-early management practice change group; n = 76). RESULTS. Only 1 (1%) of 87 infants in the pre-early management practice change group received continuous positive airway pressure treatment in the first 24 hours of life, compared with 61 (80%) of 76 infants in the post-early management practice change group. The proportions of infants who required any synchronized intermittent mandatory ventilation during their hospital stays were 98.8% and 59.5%, respectively. The mean durations of synchronized intermittent mandatory ventilation were 35 days and 15 days, respectively. The combined incidence rates of moderate and severe bronchopulmonary dysplasia at corrected gestational age of 36 weeks were 43% and 24%, respectively. The use of vasopressor support for hypotension in the first 24 hours of life decreased from 39.1% (before early management practice changes) to 19.7% (after practice changes), the cumulative days of oxygen therapy decreased from 77 ± 52 days to 56 ± 47 days, and the proportions of infants discharged with home oxygen therapy decreased from 25.7% to 10.1%; the incidence of patent ductus arteriosus requiring surgical ligation increased from 1% to 10%.There were no differences in rates of death, intraventricular hemorrhage, periventricular leukomalacia, pneumothorax, necrotizing enterocolitis, or retinopathy of prematurity. CONCLUSIONS. Successful early management of extremely preterm infants with surfactant treatment followed by continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid supplementation is possible and is associated with reductions in the incidence and severity of bronchopulmonary dysplasia.

KW - Bronchopulmonary dysplasia

KW - Continuous positive airway pressure

KW - Early amino acids

KW - Extremely low birth weight neonates

KW - Oxygen saturation

KW - Patent ductus arteriosus

KW - Prematurity

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DO - 10.1542/peds.2007-0225

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