ORIGINAL PAPER
Factors associated with SiPAP failure in late preterm infants with respiratory insufficiency
1
Department of Neonatology, Pomeranian Medical University, Police, Poland
Submission date: 2020-11-18
Final revision date: 2020-12-15
Acceptance date: 2020-12-26
Publication date: 2021-01-30
Pediatr Pol 2020;95(4):216-222
KEYWORDS
TOPICS
ABSTRACT
Introduction:
: SiPAP is a popular method of non-invasive respiratory support in Polish NICUs. Risk factors associated with treatment failure in late preterm infants are poorly understood. Aim of the study was to delineate risk factors of treatment failure when SiPAP is used as a primary modality of respiratory support following delivery.
Material and methods:
This is a retrospective study that included 184 neonates born between 2009 and 2014 with a mean gestational age (GA) of 34 3/7 weeks, and mean birth weight of 2200 grams. The parameters of ventilation during the use of SIPAP method, neonatal status and complications were compared between the failure and the success group. Success was defined as possibility of discharging from SiPAP. Failure of SiPAP method was defined as necessity for intubation with applying invasive mechanical ventilation or occurrence of pneumothorax. Logistic regression models were used to determine which factors had a significant impact on SiPAP failure.
Results:
Treatment failure was noted in 28.8% of infants. Pneumothorax was found in 4.9% of newborns treated with SiPAP. There were no significant differences in GA, birth weight, Apgar score between the groups. In the failure group, the newborns were significantly later connected to the SiPAP device; they also had significantly higher Silverman score. Congenital pneumonia (OR = 2.45), respiratory distress syndrome (RDS) grade II (OR = 5.97), intracranial hemorrhage (IVH) grade II-IV (OR = 3.29), necessity to use sedation drugs (OR = 6.05) and increase of FiO2 as well as breath rates with SiPAP (OR = 2.85; OR = 16.0) are in relation to the failure of the SIPAP.
Conclusions:
Factors associated with SiPAP failure among late preterm infants were a delay in initiation of SiPAP, severity of RDS, high oxygen requirements, and presence of grade II IVH.
: SiPAP is a popular method of non-invasive respiratory support in Polish NICUs. Risk factors associated with treatment failure in late preterm infants are poorly understood. Aim of the study was to delineate risk factors of treatment failure when SiPAP is used as a primary modality of respiratory support following delivery.
Material and methods:
This is a retrospective study that included 184 neonates born between 2009 and 2014 with a mean gestational age (GA) of 34 3/7 weeks, and mean birth weight of 2200 grams. The parameters of ventilation during the use of SIPAP method, neonatal status and complications were compared between the failure and the success group. Success was defined as possibility of discharging from SiPAP. Failure of SiPAP method was defined as necessity for intubation with applying invasive mechanical ventilation or occurrence of pneumothorax. Logistic regression models were used to determine which factors had a significant impact on SiPAP failure.
Results:
Treatment failure was noted in 28.8% of infants. Pneumothorax was found in 4.9% of newborns treated with SiPAP. There were no significant differences in GA, birth weight, Apgar score between the groups. In the failure group, the newborns were significantly later connected to the SiPAP device; they also had significantly higher Silverman score. Congenital pneumonia (OR = 2.45), respiratory distress syndrome (RDS) grade II (OR = 5.97), intracranial hemorrhage (IVH) grade II-IV (OR = 3.29), necessity to use sedation drugs (OR = 6.05) and increase of FiO2 as well as breath rates with SiPAP (OR = 2.85; OR = 16.0) are in relation to the failure of the SIPAP.
Conclusions:
Factors associated with SiPAP failure among late preterm infants were a delay in initiation of SiPAP, severity of RDS, high oxygen requirements, and presence of grade II IVH.
REFERENCES (28)
1.
Piotrowski A. Niewydolność oddechowa noworodków- zapobieganie i leczenie. Wyd. 5. alfa-medica press, Bielsko-Biała 2012.
2.
Nasef N, Rashed HME, Al H. Practical aspects on the use of non-invasive respiratory support in preterm infants. Int J Pediatr Adolesc Med 2020; 7: 21-27.
3.
Salvo V, Lista G, Lupo E, et al. Noninvasive ventilation strategies for early treatment of RDS in preterm infants: an RCT. Pediatrics 2015; 135: 444-451.
4.
Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev 2005;(3): CD001243.
5.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update. Neonatology 2019; 115: 432-450.
6.
Szczapa T. Nieinwazyjne wspomaganie oddychania u noworodków. In: Standardy opieki medycznej nad noworodkiem w Polsce – zalecenia PTN. Wyd. 3; 2019.
7.
Behnke J, Lemyre B, Czernik Ch, et al. Non-invasive ventilation in neonatology. Dtsch Arztebl Int 2019; 116: 177-183.
8.
Binmanee A, El Helou S, Shivananda S, et al. Use of high noninvasive respiratory support pressures in preterm neonates: a single-center experience. J Matern Fetal Neonatal Med 2017; 30: 2838-2843.
9.
Bhatti A, Khan J, Murki S, et al. Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial. J Perinatol 2015; 35: 935-940.
10.
Rong ZH, Li WB, Liu W, et al. Nasal bi-level positive airway pressure (BiPAP) versus nasal continuous positive airway pressure (CPAP) in preterm infants ≤ 32 weeks: a retrospective cohort study. J Paediatr Child Health 2016; 52: 493-498.
11.
Lista G, Castoldi F, Fontana P, et al. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed 2010; 95: F85-89.
12.
Victor S, Roberts SA, Mitchell S, et al. Lavender Biphasic positive airway pressure or continuous positive airway pressure: a randomized trial. Pediatrics 2016; 138: e20154095. .
13.
Permall L, Banu Pasha A, Chen X. Current insights in non-invasive ventilation for the treatment of neonatal respiratory disease. Ital J Pediatr 2019; 45: 105.
14.
Roberts CL, Badgery-Parker T, Algert CS, et al. Trends in use of neonatal CPAP: a population-based study. BMC Pediatr 2011; 11: 89.
15.
Miksch RM, Armbrust S, Pahnke J, Fusch C. Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP. Eur J Pediatr 2008; 167: 909-916.
16.
Resnick S, Sokol J. Impact of introducing binasal continuous positive airway pressure for acute respiratory distress in newborns during retrieval: experience from Western Australia. J Paediatr Child Health 2010; 46: 754-759.
17.
Zhou B, Zhai JF, Jiang HX, et al. Usefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome. Eur Rev Med Pharmacol Sci 2015; 19: 573-577.
18.
Rocha G, Flôr-de-Lima F, Proença E, et al. Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation. J Perinatol 2013; 33: 297-301.
19.
Fuchs H, Lindner W, Leiprecht A, et al. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of < 29 weeks gestational age. Arch Dis Child Fetal Neonatal Ed 2011; 96: F343-347.
20.
Dabis JM, Abman SH. Bronchopulmonary dysplasia. In: Intensive Care of the Fetus and Neonate. Spitzer AR (ed.). 2nd ed. Mosby, St. Louis 2005, p. 729-749.
21.
Tagare A, Kadam S, Vaidya U, et al. Bubble CPAP versus ventilator CPAP in preterm neonates with early onset respiratory distress- a randomized controlled trial. J Trop Pediatr 2013; 59: 113-119.
22.
Solevåg AL, Kann IC. N-BiPAP treatment in infants with respiratory distress syndrome: A population study. Early Hum Dev 2015; 91: 577-581.
23.
Iyer NP, Mhanna MJ. The role of surfactant and non-invasive mechanical ventilation in early management of respiratory distress syndrome in premature infants. World J Pediatr 2014; 10: 204-210.
24.
Longrois D, Conti G, Mantz J, et al. Sedation in non-invasive ventilation: do we know what to do (and why)? Multidiscip Respir Med 2014; 9: 56.
25.
Matsumoto T, Keisuke T, Tachikava R, et al. Role of sedation for agitated patients undergoing noninvasive ventilation: clinical practice in a tertiary referral hospital. BMC Pulm Med 2015; 15: 71.
26.
Bellù R, de Waal K, Zanini R. Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2010; 95: F241-251.
27.
Tauzin M, Durrmeyer X. Managing neonatal pain in the era of non-invasive respiratory support. Semin Fetal Neonatal Med 2019; 24: 101004.
28.
Ghazal HA, Hass HH, El-Khouly MLA. Comparison between nasal continuous positive airway pressure and mechanical ventilation after surfactant administration in preterm neonates with respiratory distress syndrome. Alex J Pediatr 2019; 32: 33-40.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
