Abstract
IntroductionRespiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature newborns. In this study, we aim to compare the reintubation rate in preterm babies with RDS who were extubated to Nasal Continuous Positive Airway Pressure (NCPAP) versus those extubated to Nasal Intermittent Positive Pressure Ventilation (NIPPV).MethodsThis is a retrospective study conducted in the Neonatal Intensive Care Unit (NICU) of Women’s Wellness and Research Center (WWRC), Doha, Qatar. The medical files (n = 220) of ventilated preterm infants with gestational age ranging between 28 weeks 0 days and 36 weeks + 6 days gestation and extubated to non-invasive respiratory support (whether NCPAP, NIPPV, or Nasal Cannula) during the period from January 2016 to December 2017 were reviewed.ResultsFrom the study group of 220 babies, n = 97 (44%) babies were extubated to CPAP, n = 77 (35%) were extubated to NIPPV, and n = 46 (21%) babies were extubated to Nasal Cannula (NC). Out of the n = 220 babies, 18 (8.2%) were reintubated within 1 week after extubation. 14 of the 18 (77.8%) were reintubated within 48 h of extubation. Eleven babies needed reintubation after being extubated to NCPAP (11.2%) and seven were reintubated after extubation to NIPPV (9.2%), none of those who were extubated to NC required reintubation (P = 0.203). The reintubation rate was not affected by extubation to any form of non-invasive ventilation (P = 0.625). The mode of ventilation before extubation does not affect the reintubation rate (P = 0.877). The presence of PDA and NEC was strongly associated with reintubation which increased by two and four-folds respectively in those morbidities. There is an increased risk of reintubation with babies suffering from NEC and BPD and this was associated with an increased risk of hospital stay with a P-value ranging (from 0.02–0.003). Using multivariate logistic regression, NEC the NEC (OR = 5.52, 95% CI 1.26, 24.11, P = 0.023) and the vaginal delivery (OR = 0.23, 95% CI 0.07, 0.78, P = 0.018) remained significantly associated with reintubation.ConclusionReintubation rates were less with NIPPV when compared with NCPAP, however, this difference was not statistically significant. This study highlights the need for further research studies with a larger number of neonates in different gestational ages birth weight categories. Ascertaining this information will provide valuable data for the factors that contribute to re-intubation rates and influence the decision-making and management of RDS patients in the future.
Highlights
Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature newborns
Reintubation rates were less with Nasal Intermittent Positive Pressure Ventilation (NIPPV) when compared with Nasal Continuous Positive Airway Pressure (NCPAP), this difference was not statistically significant
This study highlights the need for further research studies with a larger number of neonates in different gestational ages birth weight categories
Summary
Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature newborns. Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature infants. In preterm infants at-risk for or with established RDS, Nasal Continuous Positive Airway Pressure (NCPAP) is the initial preferred intervention to prevent alveolar collapse [1,2,3]. It works through splinting the pharyngeal airway with positive pressure, thereby maintaining lung recruitment and reducing the risk of both upper and lower airway collapse and obstruction. Many Randomized Controlled Trials (RCTs) and metaanalyses have shown NCPAP to be a useful method of respiratory support after extubation [4, 5]
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