ImpactofthesystematicintroductionoflowcostbubblenasalCPAPinaNICUofadevelopingcountry:aprospectivepre-andpost-interventionstudy
RossanoRezzonico,LetiziaMCaccamo,ValeriaManfredini,MassimoCartabia,NievesSanchez,ZoraidaParedes,PatriziaFroesch,FrancoCavalliandMaurizioBonati
BMCPediatrics2015,15:26doi:10.1186/s12887-015-0338-3
Published:25March2015
Abstract
Background
TheuseofNasalContinuousPositiveAirwayPressureVentilation(NCPAP)haeguntoincreaseandisprogressivelyreplacingconventionalmechanicalventilation(MV),becomingthecornerstonetreatmentfornewbornrespiratorydistresssyndrome(RDS).Howerver,NCPAPuseinLower-MiddleIncomeCountries(LMICs)ispoor.Moreover,bubbleNCPAP(bNCPAP),forefficacy,costeffectiveness,andeaseofuse,shouldbetheprimaryassistancetechniqueemployedinnewbornswithRDS.
Objective:Tomeasuretheimpactonin-hospitalnewbornmortalityofusingabNCPAPdeviceasthefirstinterventiononnewbornsrequiringventilatoryassistance.
Methods
Design:Prospectivepre-interventionandpost-interventionstudy.
Setting:ThelargestNeonatalIntensiveCareUnit(NICU)inNicaragua.
Participants:Inall,230(2006)and383(2008)patientswereincluded.
Intervention:InMay2006,astrategywasintroducedtopromotethesystematicuseofbNCPAPtoavoidintubationandMVinnewbornsrequiringventilatoryassistance.Dataregardinggestation,delivery,postnatalcourse,mortality,lengthofhospitalisation,anddurationofventilatoryassistancewerecollectedforinfantsassistedbetweenMayandDecember2006,beforetheprojectbegan,andbetweenMayandDecember2008,twoyearsafterwards.
Outcomemeasures:Thepre-vspost-interventionproportionofnewbornswhodiedin-hospitalwastheprimaryendpoint.SecondaryendpointsincludedrateofintubationanddurationofNICUstay.
Results
Significantdifferenceswerefoundintherateofintubation(72vs39%;p<0.0001)andtheproportionofpatientstreatedexclusivelywithbNCPAP(27%vs61%;p<0.0001).Mortalityratewassignificantlyreduced(40vs23%;p<0.0001);however,anincreaseinthemeandurationofNICUstaywasobserved(14.6daysin2006and17.5daysin2008,p=0.0481).
ThefindingscontributetotheevidencethatNCPAP,particularlybNCPAP,isthefirst-linestandardofcareforefficacy,costeffectiveness,andeaseofuseinnewbornswithrespiratorydistressinLMICs.
Conclusions
ThisisthefirstextensivesurveyperformedinalargeNICUfromaLMICs,provingtheefficacyofthesystematicuseofabNCPAPdeviceinreducingnewbornmortality.ThesefindingsareanincentiveforconsideringbNCPAPasanelectivestrategytotreatnewbornswithrespiratoryinsufficiencyinLMICs.
