Premature Infant Respiratory Support Guidelines Tested

Medical researchers at Children’s Hospital Boston tested a gentle form of respiratory support for premature infants instead of a mechanical ventilator and found more favorable outcomes, as well as lower treatment costs. Their results appear in the online issue of the journal Pediatrics (paid subscription required).

A team led by Bernadette Levesque of Children’s Hospital Boston and the Neonatal Intensive Care Unit (NICU) at St. Elizabeth’s Medical Center, also in Boston, tested five care guidelines intended to encourage the use of a “bubble” continuous positive airway pressure (bCPAP) system, rather than mechanical ventilators, and limit exposure to supplemental oxygen.

Babies born prematurely are often placed promptly on a mechanical ventilator with a tube in the airway (intubation) and with supplemental oxygen to help their immature lungs breathe. The excess pressure on the infant’s lungs can lead to ventilator-induced inflammation, scarring, and possible lung diseases.

The bCPAP system delivers warmed, humidified oxygen in a way that inflates a premature infant’s lungs more gently. The five guidelines were implemented in the St. Elizabeth’s NICU in 2007. They involve the exclusive use of bCPAP, making bCPAP available in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of nasal supplementary oxygen before 35 weeks of age.

The researchers compared the outcomes of 60 infants born between seven and 16 weeks premature and admitted to the St. Elizabeth’s NICU after the bCPAP guidelines were put in place with those of 61 similar infants admitted in the year before. Their results showed that those treated according to the bCPAP guidelines were less likely to be intubated or to need mechanical ventilation or surfactant that helps keep a premature infant’s lungs open, and needed fewer days on supplemental oxygen overall.

The team also recorded downward trends in the numbers of children treated for bronchopulmonary dysplasia (BPD) and low blood pressure (hypotension). BPD is a chronic lung condition that affects newborn babies who were put on a breathing machine after birth or were born prematurely.

In addition, the team found lower equipment costs associated with care for the children treated under the new guidelines, as well as reductions in medication costs related to surfactant treatment.

Levesque notes that health care providers have been moving away from mechanical ventilators for some time, but the provision of CPAP has generally been limited to the delivery room. “That’s not the whole story,” says Levesque, “and we think that by putting all five in place at the same time we are giving these children more complete support.”

Photo: Rumpleteaser/Flickr

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