Does intubation, surfactant, and extubation play a role in late preterm neonates with respiratory distress syndrome: an observational cohort study

Abstract

Background: Late preterm birth accounts for three-quarters of all preterm births. They are at increased risk of multiple respiratory morbidities. The optimal respiratory management in these babies is not standardized. Objective: The objective was to compare intubation, surfactant, and extubation to nasal continuous positive airway pressure (INSURE + NCPAP) versus NCPAP in the management of respiratory distress syndrome (RDS) in late preterm neonates. Methods: In this prospective observational cohort study, all late preterm neonates with RDS were enrolled. Infants were divided into two study groups, INSURE + NCPAP and NCPAP. Outcome measures: Primary-To compare INSURE + NCPAP versus NCPAP in late preterm neonates with RDS in terms of failure. Secondary: To compare the two groups in terms of duration of noninvasive ventilation, duration of supplementary oxygen, neonatal intensive care unit stay, mortality, and any one or more complications. Results: A total of 55 late preterm neonates with RDS were enrolled. Twenty-eight received INSURE + NCPAP, and 27 received NCPAP. There was statistically no difference between the two groups in terms of failure (P - 0.66). The duration of noninvasive ventilation was significantly less in INSURE + NCPAP as compared to NCPAP group (32.53 ± 23.18 h vs. 56.07 ± 45.91 h, P - 0.01). The duration of supplementary oxygen was significantly less in INSURE + NCPAP versus NCPAP group (36.2 ± 15.85 h vs. 55.69 ± 29.08 h, P - 0.003). Conclusion: INSURE + NCPAP therapy may be of significant benefit in late preterm neonates with RDS; additional evidence is needed from large multicenter randomized trials.