Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 89-96 (doi:10.1542/peds.2007-0225)
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ARTICLE

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

Cara Geary, MD, PhD, Melinda Caskey, MD, Rafael Fonseca, MD and Michael Malloy, MD, MS

Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas

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.

Key Words: continuous positive airway pressure • bronchopulmonary dysplasia • extremely low birth weight neonates • early amino acids • oxygen saturation • prematurity • patent ductus arteriosus

Abbreviations: BPD—bronchopulmonary dysplasia • CPAP—continuous positive airway pressure • EMPC—early management practice change • ELBW—extremely low birth weight • PDA—patent ductus arteriosus • SIMV—synchronized intermittent mandatory ventilation • FIO2—fraction of inspired oxygen

Accepted Jun 25, 2007.