Bubble CPAP may improve respiratory outcomes in labour room and NICU: Study

A recent study published in the Pediatrics journal found improved respiratory outcomes for very preterm infants by utilizing bubble continuous positive airway pressure (bCPAP) as the primary respiratory support in the delivery room (DR) and neonatal intensive care unit (NICU).

This comprehensive study from January 2012 to June 2020 assessed the impact of a multidisciplinary bCPAP protocol on infants with a gestational age of less than 32 weeks and a birth weight below 1250 grams. The study categorized the infants into four distinct periods as, pre-implementation (P0: 2012–2014) and three post-implementation phases (P1: 2014–2016, P2: 2016–2018, P3: 2018–2020).

The primary focus of the study was to evaluate the rates of death and severe bronchopulmonary dysplasia (BPD), while secondary outcomes included the need for intubation in the DR and NICU within the first seven days of life, the necessity of surfactant administration and incidences of pneumothorax. Multivariate logistic regression models were employed to adjust for relevant risk factors and calculate adjusted odds ratios (ORs).

The study encompassed a total of 440 infants who were distributed as, 90 in P0, 91 in P1, 128 in P2 and 131 in P3. Over time, significant improvements were observed:

• The rates of death and severe BPD dropped markedly post-implementation. By the third post-implementation period (P3), the odds ratio for death and severe BPD decreased to 0.37 (95% confidence interval [CI] 0.15–0.84) from the pre-implementation period by indicating a substantial reduction.
  
• The requirement for intubation in the delivery room saw a dramatic decline, from 66% in P0 to 24% in P3 for the entire cohort and from 96% to 40% in infants under 26 weeks of gestational age.
  
• While the necessity for NICU intubation remained similar across the periods, the need for surfactant decreased, albeit at higher oxygen levels (FiO2) by suggesting that infants could maintain better oxygenation with less invasive support.
  
• The rates of pneumothorax remained unchanged which indicated that the new protocol did not increase the risk of this particular adverse outcome.

The implementation of the bCPAP protocol has led to a significant and sustained improvement in respiratory practices and outcomes for very preterm infants. This protocol has reduced the rates of severe respiratory complications and the need for invasive procedures which marks a significant advancement in neonatal care. The success of this protocol highlights the importance of multidisciplinary approaches in improving the survival and health of vulnerable infants in NICU settings.

Source:

de Carvalho Nunes, G., Barbosa de Oliveira, C., Zeid, M., Leone, M., Mardakis, S., Remmer, E., Boyer, J., Hailu, E., Altit, G., Beltempo, M., Shalish, W., & Sant’Anna, G. (2024). Early Bubble CPAP Protocol Implementation and Rates of Death or Severe BPD. In Pediatrics. American Academy of Pediatrics (AAP). https://doi.org/10.1542/peds.2023-065373