J R Zubizarreta1,2, S A Lorch3,4,5,6, G Marshall7,8, I D'Apremont9, J L Tapia9. 1. Division of Decision, Risk and Operations, Columbia University, New York, NY, USA. 2. Department of Statistics, Columbia University, New York, NY, USA. 3. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 6. Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA. 7. Department of Statistics, Pontificia Universidad Catolica de Chile, Santiago, Chile. 8. Department of Public Health, Pontificia Universidad Catolica de Chile, Santiago, Chile. 9. Division de Pediatria, Departamento de Neonatologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Abstract
OBJECTIVE: The objective of this study was to examine the effect of prophylactic continuous positive airway pressure (CPAP) on infants born in 25 South American neonatal intensive care units affiliated with the Neocosur Neonatal Network using novel multivariate matching methods. STUDY DESIGN: A prospective cohort was constructed of infants with a birth weight 500 to 1500 g born between 2005 and 2011 who clinically were eligible for prophylactic CPAP. Patients who received prophylactic CPAP were matched to those who did not on 23 clinical and sociodemographic variables (N=1268). Outcomes were analyzed using the McNemar's test. RESULTS: Infants not receiving prophylactic CPAP had higher mortality rates (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.17, 2.46), need for any mechanical ventilation (OR=1.68, 95% CI 1.33, 2.14) and death or bronchopulmonary dysplasia (BPD) (OR=1.47, 95% CI 1.09, 1.98). The benefit of prophylactic CPAP varied by birth weight and gender. CONCLUSIONS: The implementation of this process was associated with a significant improvement in survival and survival free of BPD.
OBJECTIVE: The objective of this study was to examine the effect of prophylactic continuous positive airway pressure (CPAP) on infants born in 25 South American neonatal intensive care units affiliated with the Neocosur Neonatal Network using novel multivariate matching methods. STUDY DESIGN: A prospective cohort was constructed of infants with a birth weight 500 to 1500 g born between 2005 and 2011 who clinically were eligible for prophylactic CPAP. Patients who received prophylactic CPAP were matched to those who did not on 23 clinical and sociodemographic variables (N=1268). Outcomes were analyzed using the McNemar's test. RESULTS:Infants not receiving prophylactic CPAP had higher mortality rates (odds ratio (OR)=1.69, 95% confidence interval (CI) 1.17, 2.46), need for any mechanical ventilation (OR=1.68, 95% CI 1.33, 2.14) and death or bronchopulmonary dysplasia (BPD) (OR=1.47, 95% CI 1.09, 1.98). The benefit of prophylactic CPAP varied by birth weight and gender. CONCLUSIONS: The implementation of this process was associated with a significant improvement in survival and survival free of BPD.
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