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Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes
  1. Laura Sand1,
  2. Lisa Szatkowski1,
  3. T'ng Chang Kwok1,
  4. Don Sharkey1,
  5. David A Todd2,
  6. Helen Budge1,
  7. Shalini Ojha1,3
  1. 1 Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2 Neonatal Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
  3. 3 Neonatal Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  1. Correspondence to Dr Shalini Ojha, School of Medicine, University of Nottingham, Nottingham NG7 2RD, Nottinghamshire, UK; shalini.ojha{at}nottingham.ac.uk

Abstract

Objective To determine the change in non-invasive ventilation (NIV) use over time in infants born at <32 weeks’ gestation and the associated clinical outcomes.

Study design Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.

Results In 56 537 infants, NIV use increased significantly between 2010 and 2017 (continuous positive airway pressure (CPAP) from 68.5% to 80.2% in 2017 and high flow nasal cannula (HFNC) from 14% to 68%, respectively) (p<0.001)). Use of NIV as the initial mode of respiratory support also increased (CPAP, 21.5%–28.0%; HFNC, 1%–7% (p<0.001)).

HFNC was used earlier, and for longer, in those who received CPAP or mechanical ventilation. HFNC use was associated with decreased odds of death before discharge (adjusted OR (aOR) 0.19, 95% CI 0.17 to 0.22). Infants receiving CPAP but no HFNC died at an earlier median chronological age: CPAP group, 22 (IQR 10–39) days; HFNC group 40 (20–76) days (p<0.001). Among survivors, HFNC use was associated with increased odds of bronchopulmonary dysplasia (BPD) (aOR 2.98, 95% CI 2.81 to 3.15) and other adverse outcomes.

Conclusions NIV use is increasing, particularly as initial respiratory support. HFNC use has increased significantly with a sevenfold increase soon after birth which was associated with higher rates of BPD. As more infants survive with BPD, we need robust clinical evidence, to improve outcomes with the use of NIV as initial and ongoing respiratory support.

  • neonatology
  • intensive care units
  • neonatal
  • epidemiology

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party through the National Neonatal Research Database with relevant approvals. The National Neonatal Research Database is a National Data Asset, a registry containing the Neonatal Data Set (a National Data Standard). Details of data items are searchable at the following webpage: https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/isb-1595-neonatal-data-set.

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Data availability statement

Data are available on reasonable request. Data may be obtained from a third party through the National Neonatal Research Database with relevant approvals. The National Neonatal Research Database is a National Data Asset, a registry containing the Neonatal Data Set (a National Data Standard). Details of data items are searchable at the following webpage: https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/isb-1595-neonatal-data-set.

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Footnotes

  • Twitter @DrDonSharkey, @shaliniojha7

  • Contributors LSa: participated in the concept and design, performed the analysis of data, participated in interpretation of data and drafted the manuscript. LSz: participated in the concept and design, performed the analysis of data, participated in interpretation of data and drafted and revised the manuscript. TCK: participated in the concept and design, analysis of data and interpretation of data and revised the manuscript. DS: participated in the concept and design, analysis of data and interpretation of data and revised the manuscript. DAT: participated in the concept and design, interpretation of data and revised the manuscript. HB: participated in the concept and design, analysis of data and interpretation of data and revised the manuscript. SO: designed and conceptualised the study, participated in analysis and interpretation of data and drafted and revised the 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 LSa was funded by the Health Education England, Academic Foundation Training Programme. SO has received funds from the National Institute of Health Research, UK and the Medical Research Council, UK for other research.

  • 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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