Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study
The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countr...
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| description | The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.
To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.
Prospective pre-intervention and post-intervention study.
The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.
In all, 230 (2006) and 383 (2008) patients were included.
In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.
The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.
Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p |
| doi_str_mv | 10.1186/s12887-015-0338-3 |
| format | Article |
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To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.
Prospective pre-intervention and post-intervention study.
The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.
In all, 230 (2006) and 383 (2008) patients were included.
In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.
The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.
Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481). The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.
This is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.</description><identifier>ISSN: 1471-2431</identifier><identifier>EISSN: 1471-2431</identifier><identifier>DOI: 10.1186/s12887-015-0338-3</identifier><identifier>PMID: 25885437</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Continuous Positive Airway Pressure - economics ; Continuous Positive Airway Pressure - methods ; Cost-Benefit Analysis ; Delivery, Obstetric ; Developing Countries ; Economic aspects ; Equipment and supplies ; Female ; Gestational Age ; Health aspects ; Hospital Mortality ; Humans ; Infant, Newborn ; Infants (Newborn) ; Intensive Care Units, Neonatal ; Length of Stay ; Male ; Methods ; Nicaragua ; Patient outcomes ; Prospective Studies ; Respiratory Distress Syndrome, Newborn - mortality ; Respiratory Distress Syndrome, Newborn - therapy</subject><ispartof>BMC pediatrics, 2015-03, Vol.15 (1), p.26-26, Article 26</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Rezzonico et al.; licensee BioMed Central. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b558t-646ec0c7b21136e607f52c2b7b5e50719e1e4cecb414b60897fce4f66f563fde3</citedby><cites>FETCH-LOGICAL-b558t-646ec0c7b21136e607f52c2b7b5e50719e1e4cecb414b60897fce4f66f563fde3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376103/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376103/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25885437$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rezzonico, Rossano</creatorcontrib><creatorcontrib>Caccamo, Letizia M</creatorcontrib><creatorcontrib>Manfredini, Valeria</creatorcontrib><creatorcontrib>Cartabia, Massimo</creatorcontrib><creatorcontrib>Sanchez, Nieves</creatorcontrib><creatorcontrib>Paredes, Zoraida</creatorcontrib><creatorcontrib>Froesch, Patrizia</creatorcontrib><creatorcontrib>Cavalli, Franco</creatorcontrib><creatorcontrib>Bonati, Maurizio</creatorcontrib><title>Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study</title><title>BMC pediatrics</title><addtitle>BMC Pediatr</addtitle><description>The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.
To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.
Prospective pre-intervention and post-intervention study.
The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.
In all, 230 (2006) and 383 (2008) patients were included.
In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.
The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.
Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481). The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.
This is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.</description><subject>Continuous Positive Airway Pressure - economics</subject><subject>Continuous Positive Airway Pressure - methods</subject><subject>Cost-Benefit Analysis</subject><subject>Delivery, Obstetric</subject><subject>Developing Countries</subject><subject>Economic aspects</subject><subject>Equipment and supplies</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Health aspects</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infants (Newborn)</subject><subject>Intensive Care Units, Neonatal</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Methods</subject><subject>Nicaragua</subject><subject>Patient outcomes</subject><subject>Prospective Studies</subject><subject>Respiratory Distress Syndrome, Newborn - mortality</subject><subject>Respiratory Distress Syndrome, Newborn - therapy</subject><issn>1471-2431</issn><issn>1471-2431</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ks9u1DAQxiMEou3CA3BBlpBQLyl24thZDpVWy7-VKuiBni3bmewaOXaInUX7ILwvDinVrlTkgy3Pb77xzOcse0XwFSE1exdIUdc8x6TKcVnWefkkOyeUk7ygJXl6dD7LLkL4gTHhNWXPs7OiquuKlvw8-73peqkj8i2KO0DhECJ0MhqNjIuDb0YdjXdT2PpfufYhIjUqZQE5GaRF69vVbUKRRF8367uJk6iBPVjfG7dF2o9J5vA-3faDDz0kuT2kM-RIugb1STBPlWDYg_tbKcSxObzInrXSBnh5vy-yu08fv6-_5DffPm_Wq5tcVVUdc0YZaKy5KggpGTDM26rQheKqggpzsgQCVINWlFDFcL3krQbaMtZWrGwbKBfZ9azbj6qDRqc3DNKKfjCdHA7CSyNOI87sxNbvRZodI2nmi-zDLKCM_4_AaUT7Tsy2iWSbmGwTk8zl_TsG_3OEEEVnggZrpQM_BkEYp2xJSjqhb2Z0Ky0I41qfdPWEi1WV-sR8uaSJunqESquBzmjvoDXp_iTh7VHCDqSNu-DtOHkSTkEygzr5GQZoH5olWEy_8tH2Xh-P-SHj3zcs_wDtf976</recordid><startdate>20150325</startdate><enddate>20150325</enddate><creator>Rezzonico, Rossano</creator><creator>Caccamo, Letizia M</creator><creator>Manfredini, Valeria</creator><creator>Cartabia, Massimo</creator><creator>Sanchez, Nieves</creator><creator>Paredes, Zoraida</creator><creator>Froesch, Patrizia</creator><creator>Cavalli, Franco</creator><creator>Bonati, Maurizio</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150325</creationdate><title>Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study</title><author>Rezzonico, Rossano ; Caccamo, Letizia M ; Manfredini, Valeria ; Cartabia, Massimo ; Sanchez, Nieves ; Paredes, Zoraida ; Froesch, Patrizia ; Cavalli, Franco ; Bonati, Maurizio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b558t-646ec0c7b21136e607f52c2b7b5e50719e1e4cecb414b60897fce4f66f563fde3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Continuous Positive Airway Pressure - economics</topic><topic>Continuous Positive Airway Pressure - methods</topic><topic>Cost-Benefit Analysis</topic><topic>Delivery, Obstetric</topic><topic>Developing Countries</topic><topic>Economic aspects</topic><topic>Equipment and supplies</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Health aspects</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infants (Newborn)</topic><topic>Intensive Care Units, Neonatal</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Methods</topic><topic>Nicaragua</topic><topic>Patient outcomes</topic><topic>Prospective Studies</topic><topic>Respiratory Distress Syndrome, Newborn - mortality</topic><topic>Respiratory Distress Syndrome, Newborn - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rezzonico, Rossano</creatorcontrib><creatorcontrib>Caccamo, Letizia M</creatorcontrib><creatorcontrib>Manfredini, Valeria</creatorcontrib><creatorcontrib>Cartabia, Massimo</creatorcontrib><creatorcontrib>Sanchez, Nieves</creatorcontrib><creatorcontrib>Paredes, Zoraida</creatorcontrib><creatorcontrib>Froesch, Patrizia</creatorcontrib><creatorcontrib>Cavalli, Franco</creatorcontrib><creatorcontrib>Bonati, Maurizio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rezzonico, Rossano</au><au>Caccamo, Letizia M</au><au>Manfredini, Valeria</au><au>Cartabia, Massimo</au><au>Sanchez, Nieves</au><au>Paredes, Zoraida</au><au>Froesch, Patrizia</au><au>Cavalli, Franco</au><au>Bonati, Maurizio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study</atitle><jtitle>BMC pediatrics</jtitle><addtitle>BMC Pediatr</addtitle><date>2015-03-25</date><risdate>2015</risdate><volume>15</volume><issue>1</issue><spage>26</spage><epage>26</epage><pages>26-26</pages><artnum>26</artnum><issn>1471-2431</issn><eissn>1471-2431</eissn><abstract>The use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). However, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.
To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.
Prospective pre-intervention and post-intervention study.
The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.
In all, 230 (2006) and 383 (2008) patients were included.
In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.
The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.
Significant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481). The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.
This is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>25885437</pmid><doi>10.1186/s12887-015-0338-3</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Continuous Positive Airway Pressure - economics Continuous Positive Airway Pressure - methods Cost-Benefit Analysis Delivery, Obstetric Developing Countries Economic aspects Equipment and supplies Female Gestational Age Health aspects Hospital Mortality Humans Infant, Newborn Infants (Newborn) Intensive Care Units, Neonatal Length of Stay Male Methods Nicaragua Patient outcomes Prospective Studies Respiratory Distress Syndrome, Newborn - mortality Respiratory Distress Syndrome, Newborn - therapy |
| title | Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study |
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