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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