Kiran Sai, Murki Srinivas, Pratap Oleti Tejo, Kandraju Hemasree, Reddy Anupama
Department of Pediatrics, Fernandez Hospital, Hyderabad, Andhra Pradesh, 500029, India.
Indian J Pediatr. 2015 Feb;82(2):126-30. doi: 10.1007/s12098-014-1484-6. Epub 2014 Jun 21.
To evaluate the need for up-transfer after starting of nasal continuous positive airway pressure (n-CPAP) services in a Level II special newborn care unit (SNCU).
Five hundred fifty infants admitted to Level II SNCU, 252 infants during one year prior to introduction of n-CPAP (retrospective data from case records and electronic data base) and 298 infants during one year after introduction of n-CPAP services (prospective data in predefined case reporting form) were evaluated in this before and after intervention trial. The primary outcome was proportion of infants needing up-transfers from Level II SNCU for any indication.
Baseline demographic data like birth weight, gestation and other perinatal factors were similar between the two epochs. Among the infants admitted to Level II SNCU, up-transfer for any reason was significantly higher in the pre-CPAP epoch compared with CPAP epoch (n = 93, 36 % vs. n = 74, 24.8 %, p = 0.002, OR 0.56, 95 % CI 0.38 to 0.83). However parent desired up-transfers were similar between the two epochs (n = 9, 3 % vs. n = 16, 5 %, p = 0.40). Introduction of n-CPAP treatment modality reduced up-transfers in subgroups of very low birth weight infants (VLBW) (n = 20, 74 % vs. n = 15, 37 %, p = 0.003) and also in preterm infants (n = 50, 54 % vs. n = 34, 32 %, p = 0.002).
Introduction of n-CPAP services in a non-tertiary care neonatal unit, significantly reduced the need for up-transfers, especially in VLBW and preterm infants.
评估在二级特殊新生儿护理病房（SNCU）启动鼻持续气道正压通气（n-CPAP）服务后向上转诊的必要性。
在这项干预前后的试验中，对550名入住二级SNCU的婴儿进行了评估，其中252名婴儿是在引入n-CPAP前一年（来自病例记录和电子数据库的回顾性数据），298名婴儿是在引入n-CPAP服务后一年（以预定义病例报告表形式收集的前瞻性数据）。主要结局是因任何指征需要从二级SNCU向上转诊的婴儿比例。
两个时期的基线人口统计学数据，如出生体重、孕周和其他围产期因素相似。在入住二级SNCU的婴儿中，与CPAP时期相比，CPAP前时期因任何原因向上转诊的比例显著更高（n = 93，36% 对 n = 74，24.8%，p = 0.002，OR 0.56，95% CI 0.38至0.83）。然而，两个时期家长要求的向上转诊情况相似（n = 9，3% 对 n = 16，5%，p = 0.40）。引入n-CPAP治疗方式降低了极低出生体重儿（VLBW）亚组（n = 20，74% 对 n = 15，37%，p = 0.003）以及早产儿亚组（n = 50，54% 对 n = 34，32%，p = 0.002）的向上转诊率。
在非三级护理新生儿病房引入n-CPAP服务，显著降低了向上转诊的必要性，尤其是在极低出生体重儿和早产儿中。
