NEONATAL CARE OF VERY-LOW-BIRTH-WEIGHT INFANTS IN SPECIAL-CARE UNITS AND NEONATAL INTENSIVE-CARE UNITS IN STOCKHOLM - EARLY NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE VERSUS MECHANICAL VENTILATION - GAINS AND LOSSES

Very-low-birthweight (VLBW) infants are usually intubated at birth and mechanically ventilated at neonatal intensive-care units (NICUs). The objectives of this study were to evaluate the use of early nasal cont inuous positive airway pressure (NCPAP) in a regional cohort and to de termine to what extent VLBW infants need transfer to a regional NICU f rom special-care-units (SCUs) that primarily use early NCPAP for respi ratory care. We compared the outcome for infants at SCUs and NICUs in Stockholm County, Sweden, from 1988 to 1993. All infants with birthwei ghts of less than 1501 g were included in this study (n = 687). Fifty- nine per cent of the infants (400/687) were supported using only suppl emental oxygen pr NCPAP. Of these, 170 (25%) received only supplementa l oxygen and 230 (34%) were supported only by NCPAP. A total of 350 (5 1%) infants received early NCPAP. Of these infants, 120 (34%) later re quired mechanical ventilation. Only 167 (24%) infants received mechani cal ventilation from the beginning. Failure of NCPAP was significantly associated with the presence of respiratory distress syndrome. A tota l of 161/412 (39%) infants were transferred from SCUs to NICUs. Of inf ants less than or equal to 26 weeks' gestation and Infants > 26 weeks, 71% and 34% were transferred, respectively. Total mortality was 16%. The mortality for transfers was 20% compared to an overall mortality i n SCU and NICU infants of 9% and 15%, respectively. The overall incide nce of intraventricular haemorrhage (IVH), grade III-IV was 8%, perive ntricular leucomalacia (PVL grade I-IV was 7%, retinopathy of prematur ity (ROP) requiring cryotherapy was 4.3% and chronic lung disease (CLD ) was 14%. There were significant differences in the incidence of IVH, PVL, CLD and ROP between SCU and NICU infants in matched gestational age groups. In conclusion, infants with a gestational age of 27 weeks or more may often be adequately cared for at SCUs without mechanical v entilation by using early NCPAP. However, infants with a gestational a ge of 26 weeks or less should be transferred to tertiary-care centres preferably before birth, because they will often require mechanical ve ntilation.