Outcomes for infants weighing less than 1000 grams cared for with a nasal continuous positive airway pressure-based strategy

Objective: To compare outcomes for infants weighing less than 1000 g treated with a predominantly nasal continuous positive airways pressure (CPAP) approach (modelled on that of Columbia University, New York) with outcomes audited by the Australian and New Zealand Neonatal Network (ANZNN). Methods: Data on all infants weighing less than 1000 g admitted for intensive care were collected prospectively for the 29 neonatal units contributing to the ANZNN database. Outcomes for infants treated at Middlemore Hospital over a 3-year period (1998-2001) were compared with the ANZNN data for 1999. Results: Sixty-four infants were admitted to Middlemore Hospital and 954 to the other 28 neonatal units. The two groups were similar with respect to birthweight, Apgar scores, sex and delivery method. Gestational age was lower in the Middlemore infants and outcome variables were adjusted for this difference. Fewer babies at Middlemore were born to mothers who had completed antenatal corticosteroids. The Middlemore Hospital group spent longer on CPAP (P < 0.001) but had less time in oxygen (median 4 days compared to 54 days; P < 0.001). Fewer of the Middlemore cohort were in oxygen at both 28 days (odds ratio 0.17 with 95% CI 0.09-0.30) and 36 weeks corrected gestation (odds ratio 0.15 95% CI 0.07-0.32) and fewer infants were discharged home on oxygen (odds ratio risk 0.38 95% CI 0.16-0.90). Other outcomes were a reduction in the number of infants with culture proven sepsis at Middlemore Hospital but a higher rate of necrotizing enterocolitis. Length of hospital stay and survival rates were not significantly different. Conclusions: Improved respiratory outcomes for infants weighing less than 1000 g were evident at Middlemore Hospital. This was attributed to the use of a nasal CPAP-based respiratory support system.