Abstract
BackgroundThe most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications.Methods148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications.Resultsthere was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002).ConclusionsIn the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group.Trial registrationIRCT20180821040847N1, Approved on 2018-09-10.
Highlights
The most common cause of respiratory failure in premature infants is respiratory distress syndrome
respiratory distress syndrome (RDS) has been treated by injection of surfactant into the trachea followed by mechanical ventilation
Because of the risk of pulmonary injury associated with mechanical ventilation, followed by the development of chronic lung disease and other complications including subglottic stenosis and pneumonia, less invasive therapies have been proposed to reduce pulmonary complications [3]
Summary
The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. The most common cause of respiratory failure is respiratory distress syndrome (RDS) [1]. Because of the risk of pulmonary injury associated with mechanical ventilation, followed by the development of chronic lung disease and other complications including subglottic stenosis and pneumonia, less invasive therapies have been proposed to reduce pulmonary complications [3]. There are currently a number of non-invasive respiratory care options for preterm infants, including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive ventilation (NIPPV), nasal high frequency oscillation (NHFO) and high flow nasal cannula (HFNC) [5]
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