Predicting successful nasal continuous positive airway pressure treatment in newborn infants: a multivariate analysis

Background

The use of nasal continuous positive airway pressure (nCPAP) in newborn infants is common, especially for weaning after mechanical ventilation. We have reported on the successful transition to the use of the infant flow method as a standard of practice in Poland.

Objective

The authors present results of multivariate logistic regression (MLR) analysis of 481 newborns treated with the infant flow method in an effort to improve related clinical guidance.

Methods

We collected data on the baseline demographic, physiological characteristics and outcomes of 1,299 newborns treated with nCPAP in 57 neonatal ICUs in Poland over a 2-year period. We conducted a stepwise MLR of 481 newborns with the two most common indications for use. We evaluated three outcomes: need for intubation in newborns treated electively with nCPAP (RDS), weaning failure requiring reintubation in the mechanically ventilated newborns (weaning), and bad outcome.

Results

In the RDS group of patients we found that nCPAP failure was highly significantly related to estimated gestational age and clinical risk index for babies (CRIB). While in our population less mature RDS newborns were only slightly less likely to avoid intubation, the MLR model showed that, controlling for initial CRIB, they were less than one-half as likely to avoid intubation. Failure of nCPAP in weaning was highly significantly related to only pH, prior to beginning nCPAP. Bad outcomes were highly related to estimated gestational age and CRIB in the RDS group, but not the weaning population.

Conclusion

We believe that understanding the risk of both nCPAP failure and also bad outcomes for a specific patient will enhance clinical decision-making. That is, for patients with the highest risk of poor outcome or nCPAP failure, more aggressive use of intubation and surfactant might be warranted. Likewise, such aggressive therapy might also be avoided for those with a seemingly low chance of poor outcome.