Southern California Permanente Medical Group Santa Monica, California, United States
Background: Nasal intermittent positive pressure ventilation (NIPPV) has been used in the hopes of preventing endotracheal intubation or post-extubation failure. Most studies on its use have involved moderately or very preterm infants. Trends in the adoption of NIPPV into general clinical practice and endotracheal intubation have received little attention. Kaiser Permanente Southern California (KPSC), a large integrated healthcare system population, provides an opportunity to study these issues at scale. Objective: Describe population-based trends in NIPPV and endotracheal ventilation rates in inborn infants stratified by gestational age (≥ 34 weeks and < 34 weeks). Design/Methods: This cross-sectional trend analysis was conducted using data extracted from electronic health records at the KPSC healthcare system submitted to the California Perinatal Quality Care Collaborative registry. Participants included all infants born at KPSC hospitals from 01/01/2010 through 12/31/2022. Infants were stratified into those with gestational age (GA) ≥ 34 weeks and < 34 weeks. Infants with missing GA data were excluded. The annual number of infants born at KPSC hospitals exposed to NIPPV or endotracheal ventilation was estimated. Patients may have been exposed to both forms of ventilation. Rates were calculated as the number of exposures or days per inborn birth. Temporal trends in NIPPV and endotracheal ventilation were analyzed by linear regression. Results: Among infants born at GA ≥ 34 weeks, 481568 infants were inborn. NIPPV rose from 0.13% to 2.21% (b=0.19%/year, t value= 29.1, p< 0.001; R^2=0.987, F [1,11] = 849, p< 0.001) over the years. Endotracheal ventilation was 0.90% and did not change significantly over the years (b=-0.064 %/year, t value =1.51, p=0.16; R^2=0.171, F [1,11] = 2.27, p=0.16).
Among infants born at GA < 34 weeks, 11596 were inborn. NIPPV rose from 21% to 69% (b=3.81 %/year, t value=11.8, p< 0.001; R^2=0.927, F [1,11] = 140, p< 0.001) over the years. Endotracheal ventilation dropped from 42% to 39% (b=-0.40 %/year, t value=-2.42, p=0.03; R^2=0.349, F (1,11) = 5.88, p=0.04) over the years.
Conclusion(s): In this large integrated healthcare system, an 18-fold increase in NIPPV was observed over 12 years among GA ≥ 34 weeks infants without a corresponding drop in endotracheal ventilation. Over the same period, a 3-fold increase in NIPPV among GA < 34 weeks infants was observed with a small drop in endotracheal ventilation. The role and optimal application of NIPPV in neonatal care in those delivered at GA ≥ 34 weeks deserve further study.
.jpg)
.jpg)