Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm

  1. Mireille Vanpée1,
  2. Ulrika Walfridsson-Schultz1,
  3. Miriam Katz-Salamon1,
  4. John A.F. Zupancic2,
  5. DeWayne Pursley2,
  6. Baldvin Jónsson1

Article first published online: 20 DEC 2006

DOI: 10.1111/j.1651-2227.2007.00063.x

Issue

Acta Paediatrica

Acta Paediatrica

Volume 96, Issue 1, pages 10–16, January 2007

Additional Information

How to Cite

Vanpée, M., Walfridsson-Schultz, U., Katz-Salamon, M., Zupancic, J. A., Pursley, D. and Jónsson, B. (2007), Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm. Acta Paediatrica, 96: 10–16. doi: 10.1111/j.1651-2227.2007.00063.x

Author Information

  1. 1

    Neonatal Unit, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden

  2. 2

    Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

*Correspondence Mireille Vanpée, MD, PhD, Neonatal Unit, Astrid Lindgren Children's Hospital/Karolinska University Hospital, 171 76 Stockholm, Sweden. Tel: +46-08-517 72489 | Fax: +46-08-51775121 | Email: Mireille.Vanpee@kbh.ki.se

Publication History

  1. Issue published online: 20 DEC 2006
  2. Article first published online: 20 DEC 2006
  3. Received 17 March 2006; revised 18 July 2006; accepted 20 July 2006

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Keywords:

  • Bronchopulmonary dysplasia;
  • Continuous positive airway pressure;
  • Extremely preterm infants;
  • Mechanical ventilation and resuscitation

Abstract

Aim: To evaluate if different resuscitation and ventilatory styles exist between two neonatal units, and if the less aggressive approach has a beneficiary effect on BPD outcome.

Method: Inborn infants delivered at a gestational age <28 weeks were retrospectively studied (Boston = 70 and Stockholm = 102). Data were collected from birth to discharge or to 40 weeks.

Results: The study groups were similar with regard to gestational age, birth weight, gender and CRIB score, whereas SNAPPE-II score was greater in Stockholm and prenatal steroids were given less frequently in Boston. In Stockholm, continuous positive airway pressure (CPAP) was applied in the delivery room for 56% of the infants and the prevalence of infants not requiring intubation or mechanical ventilation (MV) during the first week of life was 22%. In Boston all infants were initially intubated. Subsequently, CPAP was used less often, and higher mean airway pressures (MAWPs) were applied during the first 4 weeks of life. Mortality and moderate/severe BPD at 36 weeks were similar; however, at 40 weeks oxygen supplementation was more frequent in Boston. Site was a predictor for moderate/severe BPD or death at 40 weeks.

Conclusion: Practice style differences exist and the less aggressive approach with more CPAP administration was successful. It did not decrease the risk for BPD at 36 weeks; however, at 40 weeks, fewer infants were on oxygen support, and a strong association was found between site, MAWP or MV with pulmonary morbidity indicating that CPAP could have a beneficiary role in outcome.

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