Fewer Preterm Infants in US Getting Mechanical Ventilation

By Lisa Rapaport

July 08, 2021

(Reuters Health) - The duration of respiratory support for preterm infants in the U.S. has increased in recent years as the reliance on mechanical ventilation has declined and use of noninvasive ventilation has become more common, a new study suggests.

Researchers examined data on preterm infants from a clinical cohort of 259,311 infants in the Pediatrix Clincal Data Warehouse as well as a national cohort of 1.17 million infants in the National Inpatient Sample. All the preterm infants were born before 35 weeks gestation and received care on neonatal intensive care units between 2008 and 2018.

From 2008 to 2018, the proportion of neonates in the clinical cohort receiving mechanical ventilation declined from 29.4% to 18.5% and the proportion receiving noninvasive ventilation climbed from 57.9% to 67.4%.

Over this same period, the mean number of days on respiratory support increased from 13.8 to 14.4, driven in large part by more widespread use of continuous positive airway pressure and nasal intermittent positive pressure ventilation, the study team reports in JAMA Pediatrics.

"While our study couldn't provide the exact reason why mechanical ventilation was decreasing, the decline in mechanical ventilation use seemed to begin at about the same time one of the largest clinical trials evaluating continuous positive airway pressure (CPAP) as the primary respiratory support in preterm infants was released," said Dr. Dupree Hatch, an assistant professor of pediatrics and medical director of the NICU at Vanderbilt University Medical Center in Nashville, Tennessee, who led the current study.

"This study, the SUPPORT trial, along with several other studies released about the same time caused many of us in neonatal medicine to reconsider our approach to respiratory support in preterm infants," Dr. Hatch said by email.

Over the study period, the mean duration of mechanical ventilation declined from 10.3 days to 9.7 days among infants who received this type of respiratory support. During the same period, the mean duration of noninvasive ventilation increased by 3.2 days among infants receiving this type of support.

In the national cohort analysis, researchers also found evidence of reduced use of mechanical ventilation. The proportion of preterm infants receiving this form of respiratory support declined from 22.0% to 18.5% during the study period.

One limitation of the analysis is that researchers were unable to link the two data sets, making it possible that the populations in the two cohorts might not be entirely comparable, the authors note. Changes in transfer patterns during the study period also could have influenced the outcomes.

Even so, the results underscore the importance of clinicians keeping up to date on the literature around respiratory support and carefully considering how trial outcomes might be relevant in the treatment of individual patients, said Dr. Sara DeMauro, associate director of neonatal clinical and epidemiological research at the Children's Hospital of Philadelphia, who coauthored an editorial accompanying the study.

"Mechanical ventilation usage is declining because neonatologists are concerned that exposure to mechanical ventilation is injurious, particularly to the preterm/immature lung," Dr. DeMauro said by email.

Because of this, clinicians try to avoid using mechanical ventilation, Dr. DeMauro said.

"However, premature infants typically need some kind of respiratory support, so if they are not intubated and placed on a ventilator then the next option is to provide noninvasive support," Dr. DeMauro said.

SOURCE: https://bit.ly/3yz7qik and https://bit.ly/3qSJaoQ JAMA Pediatrics, online July 6, 2021.

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