Duo Positive Airway Pressure Versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome After Surfactant Treatment

Abstract

Objective To determine whether duo positive airway pressure (DuoPAP) or continuous positive airway pressure (CPAP) can effectively reduce the need of intubation and mechanical ventilation in preterm neonates with severe neonate respiratory distress syndrome (NRDS) after surfactant treatment. Methods In this single-center, randomized controlled trial, 201 preterm infants from March 2012 to February 2013 in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of People's Liberation Army were assessed for eligibility and 129 were excluded. At last, a total of 72 infants (gestational ages at 30-34+ 6/7weeks) with NRDS were given surfactant and then randomly assigned to receive DuoPAP group (DuoPAP group, n=38) or NCPAP (NCPAP, n=34). If the two noninvasive ventilation were not effective, intubation and mechanical ventilation were used. The primary outcome were the need for mechanical ventilation within the first 72 hours of life. PaCO2, PaO2, oxygenate index (OI) were compared between the two groups in 1 h, 12 h, 24 h, 48 h, 72 h. The study protocol was approved by the Ethical Review Board of Investigation in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of People's Liberation Army. Informed consent was obtained from all participates' parents. Results Rates of intubated in the first 24 hours do not have significant difference between DuoPAP group and NCPAP groups (χ2=0.80, P=0.37), however, more infants in the DuoPAP group remained extubated compared with those in the NCPAP groups within 48, 72 hours (χ2=4.09, 4.09; P=0.04, 0.04). PaO2 at 1 h, 12 h in DuoPAP group were significantly higher than those of NCPAP group(t=2.99, 2.56; P=0.00, 0.01), there were no differences of PaO2 at 24 h, 48 h, 72 h(t=-0.40, 1.39, 0.96; P=0.69, 0.71, 0.34). PaCO2 between the two group had significant differences at 12 h, 24 h(t=-2.85, -2.84; P=0.01, 0.01), but there were no differences at 1 h, 48 h, 72 h(t=-1.72, -0.99, 0.09; P=0.09, 0.33, 0.93). There was a different of OI at 1 h, 12 h between the two groups(t=2.54, 2.46; P=0.01, 0.02), but there were no different in 24 h, 48 h, 72 h(t=-0.43, 1.04, 0.85; P=0.67, 0.30, 0.40). No significant differences were noted between 2 groups for total time of oxygen, total time on MV, Pneumothorax, necrotizing enterocolitic (NEC), persistent pulmonary hypertension of the newborn (PPHN), intraventricular hemorrhage (IVH)(grades 3 and 4), retinopathy of prematurity, ROP, septicemia, sputum culture, time to full feeds, recovery time of the birth weight, weight increasing rate and duration of hospitalization (P>0.05). Conclusions DuoPAP can decrease the need for mechanical ventilation compared with NCPAP in NRDS after surfactant treatment and worth promoting. Key words: respiratory distress syndrome; noninvasive ventilation; duo positive airway pressure; continuous positive airway pressure; bronchopulmonary dysplasia; neonate