Descriptive Analysis of Bubble Continuous Positive Airway Pressure Implementation in a Quaternary-Academic Neonatal Intensive Care Unit

Background: Bubble continuous positive airway pressure (bCPAP) in preterm infants has been associated with fewer doses of surfactant, fewer days on mechanical ventilation, and lower fraction of inspired oxygen (FIO2). Most bCPAP evidence focuses on delivery room initiation and extubation of low birth weight preterm neonates. We sought to evaluate outcomes associated with bCPAP in a diverse population admitted to a quaternary-academic neonatal intensive care unit. We hypothesize application of bCPAP is associated with decreased ventilator days, fewer surfactant doses, and shorter length of stay (LOS) in a diverse patient population. Methods: A respective analysis of neonates supported via bCPAP between July 2018 and April 2019, comparing pre- vs. post-implementation outcomes. Differences determined by student T-Test for continuous variables presented as mean ± standard deviation. Demographics, bCPAP measures, and failure rates (need for intubation) were evaluated. Outcomes included average monthly ventilator days, surfactant doses administered per month, and NICU LOS. The project was approved by the Quality Improvement Review Committee. Results: One hundred twenty-five patients were included in the study. Gestational age were 36.9 ± 7.2weeks, weight 2.4 ± 0.9 kilograms, 63 (50.4%) were male, and 28 (22.4%) had surgical intervention. Diagnostic categories illustrated in Figure 1. Duration of bCPAP support was 7.3 ± 8.7 days with an initial FIO2 of 0.32 ± 0.13 and FIO2 of 0.27 ± 0.13 at cessation of support. Fourteen (11.2%) patients failed bCPAP. Of infants successfully weaned from bCPAP, 52.8% were on room air, 26.4% were supported by low-flow nasal cannula, and 9.6% received high-flow nasal cannula. We found a significant decrease in surfactant doses per month (7.0 ± 1.0 vs. 1.3 ± 0.6; P