Duo positive airway pressure ventilation versus nasal continuous positive airway pressure in treatment of preterm neonates with severe neonatal respiratory distress syndrome after extubation

Abstract

Objective To determine whether duo positive airway pressure (DuoPAP)can decrease the rate of extubation failure in preterm neonates with severe neonatal respiratory distress syndrome (NRDS), in comparison to nasal continuous positive airway pressure (nCPAP). Methods In this single-center, randomized controlled trial, infants (gestational ages 29-346/7 weeks) with NRDS who needed endotracheal intubation and met specific predetermined criteria for extubation by day within 4 weeks of birth were enrolled.Each infant was randomized to receive either DuoPAP or nCPAP soon after extubation.Extubation was deemed successful if reintubation was not needed for at least 72 h. If the 2 noninvasive ventilations were not effective, intubation and mechanical ventilation(MV) were used.The primary outcome was the rate of extubation failure and its causes within the first 72 hours of extubation. Results In this study, 11.43% (4/35 cases) infants were failed to be extubated in DuoPAP group, but 35.29%(12/34 cases) in nCPAP group, and there was significant difference between the 2 groups (P=0.02). No significant differences were noted between the 2 groups in total time of oxygen, total time on MV, pneumothorax, necrotising enterocolitis, intraventricular hemorrhage (grades Ⅲ and Ⅳ), retinopathy of prematurity, time to full feeds, recovery time of the birth weight, weight increasing rate and duration of hospitalization. Conclusion DuoPAP can decrease the rate of extubation failure in severe NRDS compared with nCPAP. Key words: Neonatal respiratory distress syndrome; Noninvasive ventilation; Duo positive airway pressure; Continuous positive airway pressure; infant, newborn