RESUMEN
OBJECTIVE: This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support. DESIGN: Before-after observational study. SETTING: All 18 neonatal ICUs in the capital region of Poland. PATIENTS: Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after). INTERVENTION: Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems. MEASUREMENTS AND MAIN RESULTS: Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables. CONCLUSIONS: We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.
