Factors affecting outcomes in very low birth weight infants treated electively with nasal continuous positive airway pressure.

objectiveAlthough interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure. STUDY

designIn all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression.

resultIntubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO(2)/FiO(2)<150 or pH< 7.25) and Bad Outcome (FiO(2), low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria.

conclusionWe hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.