Abstract：
OBJECTIVE: To describe the effect of resuscitation with bubble CPAP (bCPAP) versus T-piece device at birth on early clinical parameters and hospital outcomes in infants born <32 weeks gestation.
METHODS: This is a single-centre pre- and post-implementation study comparing outcomes in two epochs. In epoch 1 (1 July 2013-31 December 2014), infants were managed with non-humidified gas using Neopuff® T-piece devices to support breathing after birth. In epoch 2 (1 March 2020-31 December 2021), routine application of bCPAP with humidified gas was introduced at birth.
RESULTS: Three hundred fifty-seven patients were included (176 epoch 1, 181 epoch 2). The mean gestational age was 28 ± 2 weeks. The demographics of the two epochs were comparable. There were significant improvements in outcomes of infants in epoch 2 with less infants intubated at delivery (16% vs. 4%, P ≤ 0.001), improved 5 min Apgar (7 vs. 8, P ≤ 0.001), reduced need for ventilation (21% vs. 8.8%, P ≤ 0.001), duration of ventilation in the first 72 h (9.6 vs. 4.6 h) and mortality (10.8% vs. 1.7%, P ≤ 0.001). There was, increased incidence of chronic lung disease (30% vs. 55%, P = 0.02) but no increase in infants discharged on oxygen (3.8% vs. 5%, P = 0.25). Similar findings were observed in a subgroup of infants born <25 weeks\' gestation with no increase in the incidence of CLD.
CONCLUSIONS: Introducing application of bCPAP from the first breaths in infants <32 weeks\' gestation was associated with better short-term outcomes and mortality, albeit with increased incidence of CLD. The subgroup of infants born <25 weeks\' gestation showed similar change in outcomes, with no increase in CLD.
METHODS: This is a single-centre pre- and post-implementation study comparing outcomes in two epochs. In epoch 1 (1 July 2013-31 December 2014), infants were managed with non-humidified gas using Neopuff® T-piece devices to support breathing after birth. In epoch 2 (1 March 2020-31 December 2021), routine application of bCPAP with humidified gas was introduced at birth.
RESULTS: Three hundred fifty-seven patients were included (176 epoch 1, 181 epoch 2). The mean gestational age was 28 ± 2 weeks. The demographics of the two epochs were comparable. There were significant improvements in outcomes of infants in epoch 2 with less infants intubated at delivery (16% vs. 4%, P ≤ 0.001), improved 5 min Apgar (7 vs. 8, P ≤ 0.001), reduced need for ventilation (21% vs. 8.8%, P ≤ 0.001), duration of ventilation in the first 72 h (9.6 vs. 4.6 h) and mortality (10.8% vs. 1.7%, P ≤ 0.001). There was, increased incidence of chronic lung disease (30% vs. 55%, P = 0.02) but no increase in infants discharged on oxygen (3.8% vs. 5%, P = 0.25). Similar findings were observed in a subgroup of infants born <25 weeks\' gestation with no increase in the incidence of CLD.
CONCLUSIONS: Introducing application of bCPAP from the first breaths in infants <32 weeks\' gestation was associated with better short-term outcomes and mortality, albeit with increased incidence of CLD. The subgroup of infants born <25 weeks\' gestation showed similar change in outcomes, with no increase in CLD.
摘要：
目的：描述出生时使用气泡式CPAP（bCPAP）和T型装置进行复苏对妊娠<32周婴儿的早期临床参数和医院结局的影响。
方法：这是一项单中心的实施前后研究，比较了两个时期的结果。在纪元1（2013年7月1日-2014年12月31日），使用Neopuff®T-piece装置对婴儿进行非加湿气体管理,以支持出生后的呼吸.在纪元2（2020年3月1日至2021年12月31日），出生时常规应用含加湿气体的bCPAP。
结果：纳入了三百五十七个患者（176个时期1，181个时期2）。平均胎龄为28±2周。这两个时代的人口统计学具有可比性。第2时代婴儿的结局显着改善，分娩时插管的婴儿较少（16％vs.4%,P≤0.001)，改进5分钟阿普加（7vs.8,P≤0.001),减少通风需求(21%vs.8.8%,P≤0.001)，前72小时的通气持续时间(9.6vs.4.6h）和死亡率（10.8%与1.7%,P≤0.001)。有,慢性肺病发病率增加(30%vs.55%,P=0.02），但未增加排出氧气的婴儿（3.8％vs.5%,P=0.25)。在妊娠<25周的婴儿亚组中观察到类似的发现，CLD的发生率没有增加。
结论：介绍bCPAP在妊娠<32周的婴儿首次呼吸中的应用与较好的短期结局和死亡率相关，尽管CLD发病率增加。妊娠<25周出生的婴儿亚组的结局变化相似，CLD没有增加。
方法：这是一项单中心的实施前后研究，比较了两个时期的结果。在纪元1（2013年7月1日-2014年12月31日），使用Neopuff®T-piece装置对婴儿进行非加湿气体管理,以支持出生后的呼吸.在纪元2（2020年3月1日至2021年12月31日），出生时常规应用含加湿气体的bCPAP。
结果：纳入了三百五十七个患者（176个时期1，181个时期2）。平均胎龄为28±2周。这两个时代的人口统计学具有可比性。第2时代婴儿的结局显着改善，分娩时插管的婴儿较少（16％vs.4%,P≤0.001)，改进5分钟阿普加（7vs.8,P≤0.001),减少通风需求(21%vs.8.8%,P≤0.001)，前72小时的通气持续时间(9.6vs.4.6h）和死亡率（10.8%与1.7%,P≤0.001)。有,慢性肺病发病率增加(30%vs.55%,P=0.02），但未增加排出氧气的婴儿（3.8％vs.5%,P=0.25)。在妊娠<25周的婴儿亚组中观察到类似的发现，CLD的发生率没有增加。
结论：介绍bCPAP在妊娠<32周的婴儿首次呼吸中的应用与较好的短期结局和死亡率相关，尽管CLD发病率增加。妊娠<25周出生的婴儿亚组的结局变化相似，CLD没有增加。
