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Effect of prophylactic CPAP in very low birth weight infants in South America

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Abstract

Objective:

The objective of this study was to examine the effect of prophylactic continuous positive airway pressure (CPAP) on infants born in 25 South American neonatal intensive care units affiliated with the Neocosur Neonatal Network using novel multivariate matching methods.

Study Design:

A prospective cohort was constructed of infants with a birth weight 500 to 1500 g born between 2005 and 2011 who clinically were eligible for prophylactic CPAP. Patients who received prophylactic CPAP were matched to those who did not on 23 clinical and sociodemographic variables (N=1268). Outcomes were analyzed using the McNemar’s test.

Results:

Infants not receiving prophylactic CPAP had higher mortality rates (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.17, 2.46), need for any mechanical ventilation (OR=1.68, 95% CI 1.33, 2.14) and death or bronchopulmonary dysplasia (BPD) (OR=1.47, 95% CI 1.09, 1.98). The benefit of prophylactic CPAP varied by birth weight and gender.

Conclusions:

The implementation of this process was associated with a significant improvement in survival and survival free of BPD.

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Acknowledgements

We thank all the Neocosur centers that participated in this study. The present study included the following collaborators from the Neocosur Network:

Argentina: Guillermo Colantonio, MD, Jorge Zapata, MD, Gaston Perez, MD, Liliana Rochinotti, MD, Inés Galindez, DE, Luis Prudent, MD (Clinica y Maternidad Suizo Argentina, Buenos Aires); Gonzalo Mariani, MD, Jose Maria Ceriani, MD, Silvia Fernandez, MD, Pablo Brener, MD, Carlos Fustiñana, MD (Hospital Italiano, Buenos Aires); Liliana Roldan, MD, Hector Sexer, MD, Gladys Saa, MD, Debora Sabatelli, MD, Elizabeth Lombardo, MD, Maria Laura Gendra, MD, Paula Molina, MD, Jorge Tavosnaska, MD (Hospital Juan Fernandez, Buenos Aires); Daniel Agost, MD, Gabriela Torres, MD, Jorge Rios, MD, Augusto Fischetti, MD, Monica Rinaldi, MD (Hospital Lagomaggiore, Mendoza); Carlos Grandi, MD, Elio Rojas, MD, Ricardo Nieto, MD, Javier Meritano, MD, Miguel Larguia, MD, Laura Kasten, MD, Lucrecia Cuneo, MD, Claudio Solana, MD (Maternidad Sarda, Buenos Aires); Marcelo Decaro, MD, Lionel Cracco, MD, Gustavo Bassi, MD, Noemi Jacobi, MD, Andrea Brum MD, Nestor Vain, MD (Sanatorio de la Trinidad, Buenos Aires); Adriana Aguilar, MD, Miriam Guerrero, MD, Edgardo Szyld, MD, Alcira Escandar, MD (Hospital Dr. Diego Paroissien, Buenos Aires); Daniel Abdala, MD, Martin Guida, MD, Horacio Roge, MD (Hospital Español de Mendoza); Rodolfo Keller, MD, Carola Capelli, MD, Juan Pablo Berazategui, MD Magdalena Elizalde, MD Juan Ignacio Fraga, MD Gabriel Musante, MD (Hospital Universitario Austral, Buenos Aires); Mariela Micolo, MD Alejandra Faner, MD Patricia Palacios, RN, Mirta Ferreyra, MD, Luis Ahumada, MD, (Hospital Nuestra Señora de la Misericordia, Cordoba).

Brasil: Marynea Vale, MD, Silvia Cavalcante, MD, Patricia Franco, MD, Maria Jose Silva, MD Vanda Maria Ferreira, MD, (Hospital Universidad Federal de Maranhão, Sao Luis).

Chile: Jorge Fabres, MD, Alberto Estay, MD, Alvaro Gonzalez, MD, Jose Luis Tapia, MD, Mariela Quezada, RN, Soledad Urzua, MD, Javier Kattan, MD, (Hospital Clinico Universidad Catolica de Chile, Santiago); Rodrigo Ramirez, MD, Maria Eugenia Hübner, MD, Jaime Burgos, MD, Jorge Catalan, MD (Hospital Clinico Universidad de Chile, Santiago); Lilia Campos, MD, Lilian Cifuentes, MD, Roxana Aguilar, MD, Sergio Treuer, MD, Jimena Giaconi, MD, Aldo Bancalari, MD, Jorge Leon del Pedregal, MD (Hospital Guillermo Grant, Concepcion); Marisol Escobar, MD, Viviana Veas, MD, Daniela Sandino, MD, Antonio Salvado, MD, Alejandra Nuñez, MD, Jane Standen, MD (Hospital Gustavo Fricke, Viña del Mar); Agustina Gonzalez, MD, Claudia Avila, MD, Ana Luisa Candia, MD, (Hospital San Jose, Santiago); Claudia Toro, MD, Beatriz Milet, MD, Angélica Alegria, MD, Patricia Mena, MD (Hospital Dr. Sotero del Rio, Santiago); Veronica Peña, MD, Rafael Mendizabal, MD, (Hospital San Borja Arriaran, Santiago); Gerardo Flores, MD, Erika Ortiz, RN, Johanne Jahnsen, MD, María Eugenia Aguirre, MD, Rodrigo Donoso, MD, (Hospital de Puerto Montt. Puerto Montt); Ivonne D'Apremont, MD, Mariela Quezada, RN, Solange RojasRN Guillermo Marshall, PhD, Luis Villarroel, PhD Angelica Dominguez, MSC (Unidad Base de Datos, Pontificia Universidad Catolica, Santiago).

Paraguay: Elizabeth Cespedes, MD, Ramon Mir, MD, Elvira Mendieta, MD, Larissa Genes, MD, Jose Lacarruba, MD (Departamento de Hospital de Clinicas de Asuncion).

Peru: Veronica Webb, MD, Fabiola Rivera, MD, Enrique Bambaren, MD, Marilu Rospigliosi, MD, Margarita Llontop, MD, Sicilia Bellomo, MD, Jaime Zegarra, MD (Hospital Cayetano Heredia, Lima); Oscar Chumbes, MD, Anne Castañeda, MD, Walter Cabrera, MD, Raul Llanos, MD, Jorge Mucha, MD, César Garcia, MD, (Hospital Guillermo Almenara, Lima).

Uruguay: Sandra Gugliucci, MD, Ana Lain, Alicia Prieto, Cristina Hernandez, Mariza Martinez, Gabriela Bazan, MD, Daniel Borbonet, MD, (Facultad de Medicina Servicio de Recien Nacidos, Montevideo).

No funding was secured for this study.

Author information

Author notes

  1. J R Zubizarreta and S A Lorch: Co-first author.

Authors and Affiliations

  1. Division of Decision, Risk and Operations, Columbia University, New York, NY, USA

    J R Zubizarreta

  2. Department of Statistics, Columbia University, New York, NY, USA

    J R Zubizarreta

  3. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA

    S A Lorch

  4. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA

    S A Lorch

  5. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    S A Lorch

  6. Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    S A Lorch

  7. Department of Statistics, Pontificia Universidad Catolica de Chile, Santiago, Chile

    G Marshall

  8. Department of Public Health, Pontificia Universidad Catolica de Chile, Santiago, Chile

    G Marshall

  9. Division de Pediatria, Departamento de Neonatologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile

    I D'Apremont & J L Tapia

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  1. J R Zubizarreta
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for the South American Neocosur Network

Corresponding author

Correspondence to S A Lorch.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Zubizarreta, J., Lorch, S., Marshall, G. et al. Effect of prophylactic CPAP in very low birth weight infants in South America. J Perinatol 36, 629–634 (2016). https://doi.org/10.1038/jp.2016.56

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