Noninvasive Respiratory Support Strategies for Extremely Premature Neonates
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Authors
Uram, Jamie
Issue Date
2024-05-09
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Abstract
Purpose: To implement a noninvasive respiratory support protocol, standards of practice, and an alternative, effective noninvasive respiratory support system for extremely premature neonates after birth and extubation to improve noninvasive respiratory support success.
Background: Noninvasive respiratory support failure causes increased incidences of intubation, prolonged durations of invasive mechanical ventilation (IMV) usage, and poor outcomes. Improving provisions of noninvasive respiratory support decreases morbidities and mortality in this population.
Sample/Setting: Extremely premature neonates born at less than 29 0/7 weeks gestational age managed in a Midwest level III NICU from May 2023 through January 2024.
Methods: The implemented noninvasive respiratory support system offered the ability to follow a protocol which prioritized utilizing an occlusive mask and the Nasal Intermittent Positive Pressure Ventilation (NIPPV) noninvasive mode. The changes were implemented in the included neonates (n=14) after birth and after any extubation and outcomes were followed for 10 days after. Five neonates did not exclusively utilize the implemented noninvasive respiratory support system so a separate cohort of neonates (n=9) which did were stratified.
Results: Significantly more neonates only required intubation for surfactant administration and IMV use less than 24 hours when exclusive utilization of the new noninvasive respiratory support occurred (t(8)=2.53, p<0.05). The number of intubations were significantly lower (t(13)=1.88, p<0.05; t(8)=2.45, p<0.05) even though rates of unplanned extubations were similar. Rates of noninvasive success after birth and after initial extubation attempts were significantly higher post-implementation (t(13)=2.48, p<0.05; t(8)=2.29, p<0.05) with lower cumulative durations of IMV usage post-implementation.
Conclusion: The outcomes of neonates utilizing the implemented changes to noninvasive respiratory support provisions were shown to be effective in improving noninvasive success and providers moved to full adoption of the system. This project could serve as model to improve noninvasive success in extremely premature neonates and decrease associated morbidities.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University