N-BiPAP treatment in infants with respiratory distress syndrome: A population study.

BACKGROUND

Since November 1st 2008, our Norwegian neonatal intensive care unit has used nasal biphasic positive airway pressure (n-BiPAP) instead of invasive mechanical ventilation as first-line treatment after nasal continuous positive airway pressure (n-CPAP) failure in infants with respiratory distress syndrome (RDS).

AIM: To assess utility of a national patient register to compare outcomes of infants in our unit before and after November 1st 2008 as well as to hospitals that did not utilize n-BiPAP during the observation period.

STUDY

DESIGN

A retrospective study, using a national patient register and a difference-in-difference (DID) statistical approach, adjusting for confounders.

SUBJECTS: Infants with RDS admitted to hospital 2002-2010.

OUTCOME MEASURES: We compared our unit before and after November 1st 2008 and to other hospitals with regards to morbidity, mortality, and number of hospital days (NHD).

RESULTS

Infants with RDS in our unit had a significantly lower risk of bronchopulmonary dysplasia (BPD) (odds ratio (OR) 0.59, p<0.05), retinopathy of prematurity (ROP) (OR 0.57, p<0.05), and intraventricular hemorrhage (IVH) (OR 0.37, p<0.001); as well as the combined outcome of periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), ROP, IVH, and/or BPD (OR 0.53, p<0.05) after November 1st 2008 and compared to other hospitals. PVL, NEC, and mortality did not change. NHD was reduced by 8.

CONCLUSION

Increasing use of n-BiPAP was associated with reduced morbidity and NHD in infants with RDS. Using a patient register and DID analyses may be a health economic and ethically sound way of generating hypotheses and knowledge about disease and treatment.