50 - Neurodevelopmental outcome and healthcare utilization in very low birth weight (VLBW) infants after treatment with bubble continuous positive airway pressure

Bronchopulmonary dysplasia (BPD) in preterm infants is associated with an increased risk of poor neurodevelopmental (ND) outcomes and hospital readmissions. The risk for ND is greater with prolonged mechanical ventilation (MV). The use of nasal continuous positive airway pressure (CPAP) has been shown to reduce MV and BPD. Bubble CPAP (bCPAP) has physiologic properties that decrease lung injury and promote lung volume recruitment, which may translate to better respiratory and developmental outcomes through potential prevention of BPD. However, to date, there is no study that reports the ND and health outcomes of infants treated with bCPAP.

Objective:

To evaluate the association between bCPAP treatment and ND outcome and healthcare utilization in VLBW (birth weight < 1500 grams) infants through 20 months corrected age (CA).

Design/Methods:

A retrospective cohort study of 234 infants in which 114 VLBW infants born in 2012 to 2014 who were treated with infant flow driver (IFD) CPAP were compared to 120 infants born in 2016 to 2018 treated with bCPAP. Outcomes included BPD severity as defined by Jensen et al 2019 criteria, Bayley-III index scores at 20 months CA, and use of hospitalizations, emergency room (ER), subspecialists (SS), and therapies (physical, occupational, or speech) at 1 and 2 years of life. Multiple regression analyses adjusted for the effect of social and neonatal risk factors on outcomes. Since there was a statistically significant interaction between treatment with bCPAP and birth weight < 1000 grams, this interaction term was included to model possible variation in the effect of bCPAP on index scores in extremely low birth weight (ELBW) infants.

Results:

Although there were no differences in rates of BPD, infants in the bCPAP group had lower rates of intubation (p=0.018), received less surfactant (p=0.001), and had lower rates of nasal intermittent positive pressure ventilation use (p< 0.001) as compared to infants in the IFD CPAP group. Receipt of bCPAP was not significantly associated with hospitalizations, ER visits, or SS, but was positively associated with use of therapies by age two. In ELBW infants, treatment with bCPAP was predictive of higher cognitive scores at 20 months CA (p=0.016).

Conclusion(s):

The use of bCPAP is predictive of a higher cognitive score at 20 months CA in ELBW infants. This finding was not seen for infants of birth weight >1000 grams. Further research comparing bCPAP versus other CPAP delivery systems and the rates of BPD and ND outcomes will inform treatment decisions for respiratory support that may lead to improved outcomes in VLBW infants.