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Temporal trends in respiratory care and bronchopulmonary dysplasia in very preterm infants over a 10-year period in Spain
  1. Alejandro Avila-Alvarez1,
  2. Carlos Zozaya2,
  3. Sonia Pértega-Diaz3,
  4. Manuel Sanchez-Luna4,
  5. Martin Iriondo-Sanz5,
  6. Maria Dolores Elorza6,
  7. Fermín García-Muñoz Rodrigo7
  8. Spanish Neonatal Network SEN1500
    1. 1 Neonatology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
    2. 2 Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
    3. 3 Research Support Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
    4. 4 Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    5. 5 Neonatology Department, Hospital Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital, Barcelona University, Barcelona, Spain
    6. 6 Neonatology Department, Hospital Universitario La Paz, Madrid, Spain
    7. 7 Division of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    1. Correspondence to Dr Alejandro Avila-Alvarez, Neonatology Department, Complexo Hospitalario Universitario A Coruña, 15006 A Coruna, Galicia, Spain; alejandro.avila.neonatologia{at}


    Objective To evaluate trends in respiratory care practices and bronchopulmonary dysplasia (BPD) among very preterm infants born in Spain between 2010 and 2019.

    Study design This was a retrospective cohort study of data obtained from a national population-based database (SEN1500 network). Changes in respiratory care and BPD-free survival of infants with gestational age (GA) of 230–316 weeks and <1500 g were assessed over two 5-year periods. Temporal trends were examined by joinpoint and Poisson regression models and expressed as the annual per cent change and adjusted relative risk (RR) for the change per year.

    Results A total of 17 952 infants were included. In the second period, infants were less frequently intubated in the delivery room and during neonatal intensive care unit stay. This corresponded with an increase in use of non-invasive ventilation techniques. There were no significant differences between the periods in BPD-free survival or survival without moderate-to-severe BPD. After adjusting for covariates, the RR for the change per year was significant for the following variables: never intubated (RR 1.03, 95% CI 1.02 to 1.04); intubation in the delivery room (RR 0.98, 95% CI 0.97 to 0.99); use of nasal intermittent positive pressure ventilation (RR 1.08, 95% CI 1.05 to 1.11); and BPD-free survival (only in the group with the lowest GA; RR 0.98, 95% CI 0.97 to 0.99).

    Conclusion Our findings reveal significant changes in respiratory care practices between 2009 and 2019. Despite an increase in use of non-invasive respiratory strategies, BPD-free survival did not improve and even worsened in the group with the lowest GA (230–256).

    • intensive care units
    • neonatal
    • respiratory medicine
    • neonatology

    Data availability statement

    Data supporting the findings of this study (deidentified participant data) are available upon request to the corresponding author.

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    Data availability statement

    Data supporting the findings of this study (deidentified participant data) are available upon request to the corresponding author.

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    • Collaborators Spanish Neonatal Network SEN1500: Gemma Ginovart, Josep Figueras Aloy, Alberto Pérez Legorburu, Ramon Aguilera Olmos, Eduardo Narbona López, Sandra Terroba, Tomás Sanchez-Tamayo, Dolores Elorza Fernandez, Araceli Corredera Sánchez, Belén Fernández Colomer, Ma Angeles Martinez Fernandez, Isabel de las Cuevas Terán, Miguel Ángel Cortajarena Altuna, Carmen Macias Díaz, Pedro Fuster Jorge, Segundo Rite Gracia, M Purificación Ventura Faci, M Isabel Izquierdo Macián, Ana Belén Escobar Izquierdo, M Luz Couce Pico, Elena Pilar Gutierrez González, D Blanco Bravo, M Yolanda Ruiz del Prado, Lourdes Urquía Martí, Rafael Garcia Mozo, M Pilar Jaraba Caballero, Cristina de Frutos Martínez, Sílvia Martínez-Nadal, Martin Iriondo, Amaya Rodriguez Serna, María Gonzalez Santacruz, Maria Fernanda Moreno Galdo, Joan Badia Barnusell, M Mar Montejo Vicente, Aintzane Euba, Mar Albújar, Irene Cuadrado Perez, Andres Martinez Gutierrez, Gemma Ginovart Galiana, M Jesús López Cuesta, M José Santos Muñoz, María Suárez Albo, Víctor Manuel Marugán Isabel, María Victoria Ramos Ramos, Gerardo Romera Modamio, Carolina Vizcaíno, David Mora Navarro, Laura Acosta Gordillo, Eduard Soler Mir, Mercedes Granero Asensio, Javier Estañ Capell, Miguel Angel García Cabezas, D López Gómez, Alberto Trujillo Fagundo, Israel Anquela Sanz, Antonio Segado Arenas, Carmen Rosa Pallás Alonso, Sabina Romero, Carmen González Armengod, Jose María Lloreda García, Laura Domingo Comeche, Laura Castells Vilella, Concepción Goñi Orayen, M Dolores Muro Sebastian, Alejandro Avila-Alvarez, Mara Fernandez Diaz and Elena García Victori.

    • Contributors AA-A, CZ and FG-MR conceived the study. AA-A wrote the first draft of the manuscript. CZ, FG-MR, MS-L, MDE and MI-S edited and reviewed the manuscript and made important intellectual contributions. CZ and FG-MR contributed to data selection and extraction and presentation of the results. SP-D provided guidance in statistical analysis, preparation of figures and interpretation of results. All authors discussed, revised and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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