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Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age

Journal of Perinatology volume 42, pages 761–768 (2022)Cite this article

Subjects

Abstract

Objective

We previously reported an increase in pneumothorax after implementing delivery room (DR) continuous positive airway pressure (CPAP) for labored breathing or persistent cyanosis in ≥35-week gestational age (GA) neonates unexposed to DR-positive pressure ventilation (DR-PPV). We hypothesized that pneumothorax would decrease after de-implementing DR-CPAP in those unexposed to DR-PPV or DR-O2 supplementation (DR-PPV/O2).

Study design

In a retrospective cohort excluding DR-PPV the primary outcome was DR-CPAP-related pneumothorax (1st chest radiogram, 1st day of life). In a subgroup treated by the resuscitation team and admitted to the NICU, the primary outcome was DR-CPAP-associated pneumothorax (1st radiogram, no prior PPV) without DR-PPV/O2.

Results

In the full cohort, occurrence of DR-CPAP-related pneumothorax decreased after the intervention (11.0% vs 6.0%, P < 0.001). In the subgroup, occurrence of DR-CPAP-associated pneumothorax decreased after the intervention (1.4% vs. 0.06%, P < 0.001).

Conclusion

The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O2.

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Fig. 1: Flow diagram: pneumothorax on first day of life vs. DR-CPAP and DR-O2.
Fig. 2: Changes over time (Control P charts) in exposure to DR-CPAP (Panel A) and pneumothorax during the first day of life (Panels B-D) among 6097 neonates in NICU subgroup who did not receive O2 in the delivery room during the two Epochs.

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Author information

Author notes

  1. Edward F. Stocks

    Present address: Oklahoma University, Norman, OK, USA

  2. William Smithhart

    Present address: Newborn Associates, Jackson, MO, USA

  3. Shelby Brenan

    Present address: Pediatrix, Colorado Springs, CO, USA

Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Edward F. Stocks, Mambarambath Jaleel, William Smithhart, Patti J. Burchfield, Anita Thomas, Kate Louise M. Mangona, Vishal Kapadia, Myra Wyckoff, Venkatakrishna Kakkilaya, Shelby Brenan, David B. Nelson & Luc P. Brion

  2. Parkland Health & Hospital System, Dallas, TX, USA

    L. Steven Brown, Christopher Clark & David B. Nelson

Authors
  1. Edward F. Stocks
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  2. Mambarambath Jaleel
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  4. Patti J. Burchfield
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  6. Kate Louise M. Mangona
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  7. Vishal Kapadia
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  8. Myra Wyckoff
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  9. Venkatakrishna Kakkilaya
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  11. L. Steven Brown
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  12. Christopher Clark
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  14. Luc P. Brion
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Contributions

Dr. Stocks drafted the initial manuscript and collected data. Drs Smithhart, Wyckoff, Jaleel, Kapadia, Kakkilaya and Nelson conceptualized and designed the study. Dr. Brenan planned methods of analysis. Dr. Mangona reviewed the chest radiograms of neonates with questionable pneumothorax; she was blinded to delivery room therapy. Ms. Burchfield and Ms. Thomas collected dated. Brion conceptualized and designed the project, collected, and analyzed the data. Mr. Clark worked at optimizing algorithms to extract data on pneumothorax (with Dr. Stocks) as well as DR-CPAP, DR-PPV and DR-O2 (with Dr. Brenan) from the electronic medical record system and extracted data for the full cohort. Mr. Brown analyzed the data using statistical tools. All authors participated in the interpretation of the data, critically reviewed the revisions, approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Preliminary results were published as a comment in Pediatrics17 and as an abstract to the Annual Meeting of the Pediatric Academy Societies: Stocks E, Jaleel M, Smitthart W, Burchfield P, Thomas A, Mangona, KLM, Kapadia V, Wyckoff MH, Kakkilaya V, Weaver J, Brion LP. Reduction in Delivery Room (DR) Continuous Positive Airway Pressure (CPAP)-Associated Pneumothorax in Term and Late-Preterm Neonates. Accepted for oral presentation at PAS, Philadelphia, PA, 5/2/2020; cancelled for COVID-19/SARS-Cov-2; presented online at Virtual Regional Neonatal Research Conference 6/16/2020. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author

Correspondence to Luc P. Brion.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This project was initially approved as quality improvement by the University of Texas Southwestern Medical Center Institutional Review Board and by Parkland Health and Hospital Systems. The entire project including the retrospective full cohort as described was later approved as a research project. The need for informed consent was waived for the entire project.

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Stocks, E.F., Jaleel, M., Smithhart, W. et al. Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age. J Perinatol 42, 761–768 (2022). https://doi.org/10.1038/s41372-022-01334-4

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