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Bubble CPAP
Best way to treat Respiratory Distress in Neonates
Jay Kothadia, MDPediatrix Medical Group
Presbyterian HospitalCharlotte, NC
Average Daily Census 2000-2007
32 3128
3438 39
4246
0
5
10
15
20
25
30
35
40
45
50
2000 2001 2002 2003 2004 2005 2006 2007
Hemby ICN Average Daily Census
Monthly Average Daily Census Presbyterian Hemby ICN
2006
3944 44 46
3336
43 4440
48 48 50
0
10
20
30
40
50
60
jan feb march april may june july aug sept oct nov dec
ICN Average Daily Census
ICN SURVIVAL 2003-2006Gestational Age94.6% Survival
N = 1,836
0102030405060708090
100
<=23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 >=38
% Survival by Gestational Age (weeks)
02 Saturation ManagementApril 2005
Bubble CPAPApril 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.
262
108110
0
50
100
150
200
250
300
Survanta Vials / yr
200520062007
Annual Survanta usage
$154,600
$48,750$45,360
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
Survanta Expense/Yr
200520062007
Sufactant Expense 2005-2007
Average Ventilator days by GA 2004-2006
0102030405060708090
100
VentilatorDays
23 24 25 26 27 28 29 30
Gestational Age (in Weeks)
200420052006
< 30 wks GA babies diagnosed with Hypotension2004-2006
Hypotension2004-2006
23
4245
19
3434
05
101520253035404550
2004 2005 2006Year
Perc
ent o
f Bab
ies Percent of Babies <
30 Wks. WithDiagnosis ofHypotension
Percent of Babies <30 Wks. WithDiagnosis ofHypotension ThatSurvived
< 30 wks GA babies treated with Dopamine or Dobutamine 2004-2006
39 38
2016
30 31
05
1015202530354045
2004 2005 2006Year
Perc
ent o
f Bab
ies
Percent of Babies < 30Wks. Treated withDopamine/Dobutamine
Percent of Babies < 30Wks. Treated WithDopamine/DobutamineThat Survived
< 30 wks GA babies treated with Decadron2004-2006
< 30 wks GA babies treated with Decadron2004-2006
33
25
17
32
23
14
0
5
10
15
20
25
30
35
2004 2005 2006Year
Perc
ent o
f Bab
ies Percent of Babies <
30 Wks. onDecadron
Percent of Babies <30 Wks. onDecadron ThatSurvived
25
0
22
9
25
7
1
2
00
0 00
5
10
15
20
25
23 24 25 26 27 28
BeforeAfter
Surgical ROP before and after O2 saturation change (percent)
< 30 wks GA babies discharged home on Oxygen 2004-2007
010203040506070
24 25 26 27 28 29 30Year
Perc
ent o
f Bab
ies
Percent of Babies < 30Wks. Dischared homeon O2 2004-2005
Percent of Babies < 30Wks. Discharged homeon O2 2006-2007
< 30 wks GA babies: Average length of stay 2004-2007
020406080
100120140
24 25 26 27 28 29 30GA
Day
s
ALOS (days) < 30 Wks.Dischared home 2004-2005
ALOS (days) < 30 Wks.Discharge home 2006-2007
Average Length of Stay (Days)Hemby Intensive Care Nursery
2004-2006
35
29.326
0
5
10
15
20
25
30
35
40
2004 2005 2006
Presbyterian Hospital ICN
a
ICN SURVIVAL 2004-2007Gestational Age
0102030405060708090
100
<=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