Nasale CPAP: Een kwaliteitsverbetering bij prematuur geboren kinderen

Introduction: Continuous positive airway pressure (CPAP) is increasingly being used in the care of preterm infants. There are a variety of complex mechanisms by which this is achieved. With the introduction of a dedicated CPAP device (the Infant Flow), it seems that in daily practice the need for mechanical ventilation decreases. Aim of study: To compare outcome of morbidity and mortality in two groups of NICU patients treated with two different nasal CPAP devices. Subjects: Neonates < 32 weeks and < 1500 grams admitted to the Neonatal Intensive Care Unit at the Wilhelmina Children's Hospital, Utrecht, were included. 592 neonates in period 1 (January 2, 1999-September 27, 2001) and 349 neonates in period 2 (July 2, 2002-December 31, 2003) were compared. Neonates in period 1 were treated with nCPAP with constant flow produced by a regular ventilator (Stephanie). Neonates in period 2 were treated with nCPAP with variable flow applied by the Infant Flow. Methods: Retrospectively clinical characteristics, mortality, antenatal and postnatal corticosteroids, IRDS, BPD, surfactant suppletion, NEC, PDA, sepsis, IVH, PVL and ROP were compared. Additionally the numbers of ventilation days were compared. Results: Clinical characteristics were comparable. In period 2 mortality was significantly lower (p < 0.01). The use of postnatal corticosteroids was significantly less in period 2 (p < 0.001), the group using the Infant Flow. A significant reduction of ventilation days was found in period 2: mean ventilation days 4.8 d, SD 0.5, compared with period 1: mean ventilation days 7.4 d, SD 0.5 (p < 0.05). Conclusions: In this study a lower mortality, less use of postnatal corticosteroids and a lower number of ventilation days was demonstrated with the use of a dedicated nasal CPAP device. With a dedicated nCPAP device quality of care improved in preterm infants.