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Acta Paediatr. 2007 Jan;96(1):10-6; discussion 8-9.

Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm.

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  • 1Neonatal Unit, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden. Mireille.Vanpee@kbh.ki.se

Abstract

AIM:

To evaluate if different resuscitation and ventilatory styles exist between two neonatal units, and if the less aggressive approach has a beneficiary effect on BPD outcome.

METHOD:

Inborn infants delivered at a gestational age <28 weeks were retrospectively studied (Boston = 70 and Stockholm = 102). Data were collected from birth to discharge or to 40 weeks.

RESULTS:

The study groups were similar with regard to gestational age, birth weight, gender and CRIB score, whereas SNAPPE-II score was greater in Stockholm and prenatal steroids were given less frequently in Boston. In Stockholm, continuous positive airway pressure (CPAP) was applied in the delivery room for 56% of the infants and the prevalence of infants not requiring intubation or mechanical ventilation (MV) during the first week of life was 22%. In Boston all infants were initially intubated. Subsequently, CPAP was used less often, and higher mean airway pressures (MAWPs) were applied during the first 4 weeks of life. Mortality and moderate/severe BPD at 36 weeks were similar; however, at 40 weeks oxygen supplementation was more frequent in Boston. Site was a predictor for moderate/severe BPD or death at 40 weeks.

CONCLUSION:

Practice style differences exist and the less aggressive approach with more CPAP administration was successful. It did not decrease the risk for BPD at 36 weeks; however, at 40 weeks, fewer infants were on oxygen support, and a strong association was found between site, MAWP or MV with pulmonary morbidity indicating that CPAP could have a beneficiary role in outcome.

[PubMed - indexed for MEDLINE]
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