During 2003 NCPAP became the preferred alternative to mechanical ventilation in our NICU for management of respiratory distress syndrome (RDS).
Objectives To assess the impact of NCPAP on the need for intubation and days on the ventilator and to characterize the NCPAP course for each gestational age (GA).
Design/Methods Infants with RDS were intubated, given surfactant, then extubated to NCPAP. They were re-intubated and ventilated for unacceptable hypoxemia, hypercarbia, or profound apnea but placed back on NCPAP when feasible. 2002 was defined as pre-NCPAP; Jan-Sept 2004 was defined as post-NCPAP. Deaths were excluded from data analysis.
Results Monthly ventilator days decreased from 236 ± 44 pre-NCPAP to 117 ± 7 post-NCPAP (means ± SD, p < .0001, Student's t-test). The number of babies intubated monthly decreased from 28 ± 3 pre-NCPAP to 15 ± 3 post-NCPAP (p < .0001). The number of babies ventilated (% on Vent) and the mean time each baby required ventilator support (Days on Vent) decreased within each GA group (Table). GA was inversely related to days on NCPAP and to postconceptual age (PCA) and weight at NCPAP discontinuation (Table).
Conclusions NCPAP reduces the need for mechanical ventilation in neonates at all gestational ages. Babies ≥ 25 weeks GA are weaned from NCPAP at a mean of approximately 31. Studies in progress will determine the impact of NCPAP on hospital stay, pulmonary outcome, and other comorbidities.