Bubble CPAP

Best way to treat Respiratory

Distress in Neonates

Jay Kothadia, MD
Pediatrix Medical Group
Presbyterian Hospital
Charlotte, NC
 Average Daily Census 2000-2007
50
45
46
40 42
35 38 39
34
30 32 31
25 28
20
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007

Hemby ICN Average Daily Census

 Monthly Average Daily Census
Presbyterian Hemby ICN
2006

60

50
50
48 48
46
40 44 44 43 44
39 40
36
30 33

20

10

0
jan feb march april may june july aug sept oct nov dec

ICN Average Daily Census

 ICN SURVIVAL 2003-2006
Gestational Age
94.6% Survival
N = 1,836
100
90
80
70
60
50
40
30
20
10
0
<=23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 >=38

% Survival by Gestational Age (weeks)

02 Saturation Management
April 2005
Bubble CPAP
April 2006
 CPAP advantages
• Stabilizes alveoli, prevents collapse or
atelectasis.
• Achieves better lung volume
• Provides better ventilation/perfusion match
• Conserves surfactant
• Increases lung compliance
 CPAP advantages
• Decreases need for intubation's, surfactant
and mechanical ventilation.
• Improved work of breathing.
• Lower concentration of FiO2 need.
• Decreases days on O2.
• Lower risk for BPD.
 CPAP advantages
• Decreases Ventilator associated
Pneumonias.
• Decreases risk for nosocomial sepsis.
• Decreases severity of ROP.
• Possible better growth.
• May decreases length of Hospital stay.
 Annual Survanta usage
300 262

250

200

2005
150 108 2006
110 2007
100

50

0
Survanta Vials / yr
Sufactant Expense 2005-2007
$154,600
$160,000

$140,000

$120,000

$100,000
2005
$80,000 2006
$48,750
2007
$60,000 $45,360
$40,000

$20,000

$0
Survanta Expense/Yr
 Average Ventilator days by GA
2004-2006
100
90
80
70
60
Ventilator
50 2004
Days
40 2005
30 2006
20
10
0
23 24 25 26 27 28 29 30
Gestational Age (in Weeks)
< 30 wks GA babies diagnosed with Hypotension
2004-2006
Hypotension
2004-2006

50
45
Percent of Babies <
Percent of Babies

40 30 Wks. With
45 42
35 Diagnosis of
30 Hypotension
34 34
25
Percent of Babies <
20 30 Wks. With
15
23 Diagnosis of
19 Hypotension That
10
Survived
5
0
2004 2005 2006
Year
 < 30 wks GA babies treated with Dopamine or
Dobutamine 2004-2006

45
39 38
40
Percent of Babies

35 30 31 Percent of Babies < 30

Wks. Treated with
30 Dopamine/Dobutamine
25 20
Percent of Babies < 30
20 16 Wks. Treated With
15 Dopamine/Dobutamine
That Survived
10
5
0
2004 2005 2006
Year
< 30 wks GA babies treated with Decadron
2004-2006

< 30 wks GA babies treated with Decadron

2004-2006

35 33 32

30 Percent of Babies <

25
Percent of Babies

30 Wks. on
25 23 Decadron

20 17 Percent of Babies <

30 Wks. on
14
15 Decadron That
Survived
10
5
0
2004 2005 2006
Year
Surgical ROP before and after O2 saturation
change (percent)
25
25
25

20
22

15

Before
9 After
10
7

5
2

0 0 0 0 0
23 24 25 126 27 0 28
 < 30 wks GA babies discharged home on Oxygen
2004-2007

70
60
Percent of Babies

Percent of Babies < 30

50 Wks. Dischared home
40 on O2 2004-2005

30 Percent of Babies < 30

Wks. Discharged home
20 on O2 2006-2007

10
0
24 25 26 27 28 29 30
Year
 < 30 wks GA babies: Average length of stay
2004-2007

140
120
ALOS (days) < 30 Wks.
100 Dischared home 2004-
Days

80 2005

60 ALOS (days) < 30 Wks.

Discharge home 2006-
40 2007

20
0
24 25 26 27 28 29 30
GA
 Average Length of Stay (Days)
Hemby Intensive Care Nursery
2004-2006
40
35
35
30
25 29.3
26
20
15 à

10
5
0
2004 2005 2006

Presbyterian Hospital ICN

 ICN SURVIVAL 2004-2007
Gestational Age
100
90
80
70
60
50
40
30
20
10
0
<=23 24 25 26 27 28 29 30

% Survival by GA (weeks) 2004-05

% Survival by GA (weeks) 2006-07
 Starting Bubble CPAP
• Dedicated team
• Education
• Equipment and supply
• Criteria to place on CPAP
• Monitor placement
Bubble CPAP