A prospective randomizedcontrolled trial of synchronized nasal intermittent positive pressure ventilation intreatment of hyaline membrane disease in premature infants

Abstract

：Objective To assess theefficacy of synchronized nasal intermittent positive pressure ventilation (SNIPPV) asprimary treatment of hyaline membrane disease (HMD) in premature infants. Methods Aprospective randomized controlled trial was conducted. Preterm infants, who were diagnosedas HMD, admitted to the neonatal intensive care unit of Peking University Third Hospitalfrom March 2008 to March 2009 were recruited in the study group. Non-invasive ventilationwere given to the infants who still breath with difficulty after surfactant therapy.Twenty infants were randomized to SNIPPV group and 22 comparable infants to NCPAP group.Vital signs, blood gas analysis and prevalence of non-invasive ventilation failure andcomplications were compared between the two groups, t test and x~2 test were used forstatistical analysis. Results Infants treated initially with SNIPPV had a higher PaQ_2level [(78. 3±17. 6) vs (62. 5±20.5) mm Hg, P<0.05, and (83. 3±17. 7) vs (69. 6±18.8) mm Hg, P<0. 05] and lower PaCQ_2 level [(42.2±12.2) vs (53.7±11.0) mm Hg,P<0.05, and (41.4±11.2) vs (55.3±10.9) mm Hg, P<0.05] than those treated withNCPAP after 3 and 12 hours' ventilation, respectively. SNIPPV group had a decreasedincidence of hypoxemia and hyperbicarbonatemia than NCPAP group after 3 hours' ventilation(5. 0% vs 36.4%, P<0.05,and 20.0% vs 50.0%, P<0.05),and a decreased incidence ofhyperbicarbonatemia after 12 hours' ventilation(20.0% vs 59.1%, x~2=6.654,P=0.010).Infants treated initially with SNIPPV had lower incidence of non-invasive ventilationfailure than infants treated with NCPAP(15. 0% vs 45. 5%, x~2 =4.456, P=0.033). There wasno significant difference on the prevalence of complications between the two groups.Conclusions SNIPPV as a primary measure applied after surfactant therapy is feasible inventilation of premature infants with HMD and is more effective than NCPAP.