Management Of Respiratory Distress Syndrome Research Articles

Reverse diastolic flow of the fetal middle cerebral artery associated with placental chorangiomatosis and asymptomatic concealed placental abruption

Reverse diastolic flow of the fetal middle cerebral artery is a rare, yet ominous finding which has been associated with adverse perinatal outcomes including: intracranial hemorrhage, growth restriction, fetal-maternal hemorrhage, severe anemia, hydrops, hepatic anomaly, subsequent stillbirth, and early neonatal death. We report a case in which following notation of a nonreassuring fetal heart rate at 32 weeks' gestation, sonographic documentation of persistent reverse diastolic flow of the fetal middle cerebral artery was noted in association with sonographic findings of vascular placental dysmorphology and an asymptomatic concealed placental abruption. Subsequent fetal heart rate tracing consistent with uteroplacental insufficiency led to immediate Cesarean birth of an anemic yet nonacidotic, nonhypoxic neonate, who did well following management of respiratory distress syndrome and partial exchange transfusion. Placental abruption was confirmed at delivery. Histopathology of the placenta confirmed the presence of localized chorangiomatosis ("wandering" chorangioma). The association of reverse diastolic flow of the fetal middle cerebral artery, placental chorangiomatosis and placental abruption has not been reported previously. We conclude that in the presence of prenatal sonographic findings of placental dysmorphology and or placental abruption, insonation of the fetal middle cerebral artery should be performed to assess the possibility of increased peak systolic velocity and possible reverse diastolic flow, both associated with fetal anemia and increased likelihood of an adverse perinatal outcome.

Trends in the management of respiratory distress syndrome in very preterm infants transferred to the Clinical Center of the University of Debrecen

Although in utero transport is recommended in the case of threatening preterm delivery, it is not always possible. Management during postnatal transport may influence neonatal outcomes. The aim of this study was to investigate the trends in patient characteristics, respiratory management and outcomes in very preterm infants requiring postnatal transfer between 2008 and 2021. We conducted a retrospective study. Data were collected from both written and electronic medical records. Trends were assessed using joinpoint regression analysis and summarized as annual percentage changes (APC). A total of 177 infants were included. The number of transfers per year showed non-significant increase over time (APC = 6.8%, p = 0.087). The proportion of time above 60 minutes for care provided by the transport team at the referral site significantly increased (APC = 7.4%, p = 0.016). Between 2008 and 2010, the use of mechanical ventilation during transports increased (APC = 36.4%, p = 0.578), then it showed a decreasing trend during the rest of the study period (APC = -7.2%, p = 0.068). The use of oxygen concentrations above 40% significantly decreased (APC = -9.5%, p = 0.043). The proportion of surfactant doses less than 150 mg/kg showed a decreasing trend (APC = -7.65%, p = 0.162), while doses above 180 mg/kg significantly increased over time (APC = 8.5%, p = 0.031). Neonatal long-term outcome indicators showed improving trends. We observed relevant trends toward non-invasive approaches and improving outcomes. Our study can facilitate the ongoing change of approach to care during postnatal transport, promote the development of relevant protocols and guidelines, which together can improve the outcome of preterm infants born outside tertiary care centers. Orv Hetil. 2023; 164(15): 571-576.

Respiratory management in the premature neonate

Introduction : Advances in neonatal care have made possible the increased survival of extremely preterm infants. Even though there is widespread recognition of the harmful effects of mechanical ventilation on the developing lung, its use has become imperative in the management of micro-/nano-premies. There is an increased emphasis on the use of less-invasive approaches such as minimally invasive surfactant therapy and non-invasive ventilation that have been proven to result in improved outcomes. Areas covered : Here, we review the evidence-based practices surrounding the respiratory management of extremely preterm infants including delivery room interventions, invasive and non-invasive ventilation approaches and specific ventilator strategies in respiratory distress syndrome and bronchopulmonary dysplasia. Adjuvant relevant respiratory pharmacotherapies used in preterm neonates are also discussed. Expert opinion : Early use of non-invasive ventilation and use of less invasive surfactant administration are key strategies in the management of respiratory distress syndrome in preterm infants. Ventilator management in bronchopulmonary dysplasia must be tailored according to the individual phenotype. There is strong evidence to start caffeine early to improve respiratory outcomes, but evidence is lacking on the use of other pharmacological agents in preterm neonates, and an individualized approach has to be considered for their use.

Diagnosis and management of neonatal respiratory distress syndrome in Japan: A national survey.

Respiratory distress syndrome (RDS) is characterized by a lack of lung surfactant; therefore, biochemical evidence of surfactant deficiency is needed to diagnose RDS. European guidelines recommend surfactant administration when patients need fraction of inspired oxygen exceeding 0.3 on continuous positive airway pressure or intubation. We hypothesized that the European guidelines for surfactant administration were not adopted in Japan because of the lack of RDS diagnosis. This study aimed to investigate neonatologists' attitudes and practices regarding the diagnosis and management of RDS in Japan. A mail-based survey regarding the diagnosis and management of RDS was conducted at 111 level III or ΙV neonatal intensive care units in Japan. The questionnaire was completed by the person in charge of each unit. The overall response rate for the questionnaire was 91% (101/111 centers). All respondents referred to chest radiography, and the majority (83%) of respondents referred to stable microbubble rating (SMR) for establishing the diagnosis of RDS. Surfactant administration was chiefly based on clinical conditions, chest radiography, and/or SMR. Most units in Japan do not adopt the European criteria for surfactant administration. In Japan, chest radiography and/or SMR are commonly used for the diagnosis of RDS and as the rationale for surfactant administration. Further studies from other countries are required to establish the ideal criteria for surfactant administration.

Prevalence and Outcome of Management of Respiratory Distress Syndrome: A Systematic Review

The main goal of this review is about Respiratory distress syndrome, which starts within hours of delivery, is really a major cause of neonatal respiratory distress; it remains a leading cause of morbidity and mortality in preterm infants. The following search databases were used PubMed, the Web of Science, Science Direct, EBSCO, and the Cochrane Library. Utilizing Rayyan QCRI, studies papers were screened by title and abstract before being subjected to a full-text evaluation. This review invest

Lung ultrasound to guide the administration of exogenous pulmonary surfactant in respiratory distress syndrome of newborn infants: A retrospective investigation study.

Respiratory distress syndrome (RDS) is a common disease that seriously endangers the life and safety of newborns, especially premature infants. Exogenous pulmonary surfactant (PS) is the specific agent for the treatment of neonatal RDS. Lung ultrasound (LUS) has been successfully used in the diagnosis of RDS, but its value in guiding the application of PS is still unclear. This paper explored whether the application of PS under LUS monitoring has some advantages, including (1) decreasing the misdiagnosis rate of RDS and decreasing probability of using PS, and (2) reducing the dose of PS without reducing the therapeutic effect. This study included two parts. Part 1: To decide whether the LUS is good to differentiate RDS from other lung diseases in the premature infants. All patients who were diagnosed with RDS and required PS treatment based on conventional criteria were routinely examined by LUS. Then, according to LUS findings, we decided whether they needed to receive PS treatment. Part 2: To see the dose reduction of surfactant is applicable. In RDS patients diagnosed based on LUS presentation and treated with Curosurf (Chiesi Pharmaceutical, Parma, Italy), the dose of Curosurf was compared with that recommended by the European RDS management guidelines. (1) Since March 2017, 385 newborn infants admitted to our neonatal intensive care unit met the traditional diagnostic criteria of RDS. Of these, only 269 cases were diagnosed with RDS and needed PS treatment according to LUS manifestations. The other 116 infants who did not meet the criteria for ultrasound diagnosis of RDS did not receive PS supplementation but obtained good outcomes, that is LUS findings decreased a misdiagnosis rate of RDS by 30.1% and subsequently resulted in a 30.1% reduction in PS use. (2) Among the 269 RDS patients diagnosed based on LUS findings, 148 were treated with Curosurf (another 121 RDS infants who received domestic PS treatment were not included in the study group), and the average dose was 105.4 ± 24.3 mg/kg per time, which is significantly lower than the dose of 200 mg/kg per time recommended by the European RDS guidelines. (3) The mortality rate of RDS patients was 0%, and no patients had ventilator-associated pneumonia or bronchopulmonary dysplasia in this study. LUS can decrease the misdiagnosis rate of RDS, thereby decreasing the probability of using PS and decreasing the dose of PS, and can help RDS infants to achieve better outcomes.

Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022.

The complications of prematurity are the leading cause of neonatal mortality worldwide, with the highest burden in the low- and middle-income countries of South Asia and Sub-Saharan Africa. A major driver of this prematurity-related neonatal mortality is respiratory distress syndrome due to immature lungs and surfactant deficiency. The World Health Organization's Every Newborn Action Plan target is for 80% of districts to have resources available to care for small and sick newborns, including premature infants with respiratory distress syndrome. Evidence-based interventions for respiratory distress syndrome management exist for the peripartum, delivery and neonatal intensive care period- however, cost, resources, and infrastructure limit their availability in low- and middle-income countries. Existing research and implementation gaps include the safe use of antenatal corticosteroid in non-tertiary settings, establishing emergency transportation services from low to high level care facilities, optimized delivery room resuscitation, provision of affordable caffeine and surfactant as well as implementing non-traditional methods of surfactant administration. There is also a need to optimize affordable continuous positive airway pressure devices able to blend oxygen, provide humidity and deliver reliable pressure. If the high prematurity-related neonatal mortality experienced in low- and middle-income countries is to be mitigated, a concerted effort by researchers, implementers and policy developers is required to address these key modalities.

New developments in neonatal respiratory management.

Respiratory distress syndrome (RDS) is the major cause of respiratory failure in preterm infants due to immature lung development and surfactant deficiency. Although the concepts and methods of managing respiratory problems in neonates have changed continuously, determining appropriate respiratory treatment with minimal ventilation-induced lung injury and complications is crucially important. This review summarizes neonatal respiratory therapy's advances and available strategies (i.e., exogenous surfactant therapy, noninvasive ventilation, and different ventilation modes), focusing on RDS management.

THE ULTRASOUND GRADING OF NEONATAL RESPIRATORY DISTRESS SYNDROME

TYPE: Abstract TOPIC: Pediatrics PURPOSE: Respiratory distress syndrome (RDS) used to be diagnosed by chest X-ray,can now be diagnosed by ultrasound with higher accuracy and reliability.With the increasing application of lung ultrasound,it is necessary to master the methods and standards of ultrasound grading in order to better manage RDS patients. METHODS: RDS was divided into three degrees by ultrasound manifestations and whether has resulted in severe complications. RESULTS: Grade Ⅰ RDS: mainly presents as GOS-like lung consolidation on ultrasound.GOS is a kind of mild lung consolidation with no obvious air bronochograms,the echogenicity in the near-field is higher and gradually decreases from shallow to deep,which looks-like the groundglass opacity. Grade Ⅱ RDS:mainly manifests as a kind of snowflake signs-like lung consolidation on ultrasound,but the consolidation has not yet involved all of the lung fields. Grade Ⅲ RDS: Those with any one or more of the following points are determined as grade Ⅲ RDS :(1)snowflake signs (SFS)-like lung consolidation already affecting 12 regions of the lung.(2)If SFS-like lung consolidation does not involve all of the lung fields,but has caused serious complications,such as pulmonary hemorrhage,or/and pneumothorax or/and persistent pulmonary hypertension of newborn or/and large area of atelectasis,etc. CONCLUSIONS: How to grade the RDS bu ultrasound was also described here,which is useful for ultrasound and clinical physicians to manage the neonatal RDS patients.Grade Ⅰ RDS is easy to misdiagnose as TTN,that is the GOS is easy to was mistaken for confluent B-lines,which was introduced clear in this short paper. CLINICAL IMPLICATIONS: Management of RDS under the monitoring of LUS can improve patient outcomes. DISCLOSURE: Nothing to declare. KEYWORD: respiratory distress syndrome;transient tachypnea of the newborn;lung ultrasound; ultrasound graduat

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome Management.

To describe, through a narrative review, the physiologic principles underlying electrical impedance tomography, and its potential applications in managing acute respiratory distress syndrome (ARDS). To address the current evidence supporting its use in different clinical scenarios along the ARDS management continuum. We performed an online search in Pubmed to review articles. We searched MEDLINE, Cochrane Central Register, and clinicaltrials.gov for controlled trials databases. Selected publications included case series, pilot-physiologic studies, observational cohorts, and randomized controlled trials. To describe the rationale underlying physiologic principles, we included experimental studies. Data from relevant publications were reviewed, analyzed, and its content summarized. Electrical impedance tomography is an imaging technique that has aided in understanding the mechanisms underlying multiple interventions used in ARDS management. It has the potential to monitor and predict the response to prone positioning, aid in the dosage of flow rate in high-flow nasal cannula, and guide the titration of positive-end expiratory pressure during invasive mechanical ventilation. The latter has been demonstrated to improve physiologic and mechanical parameters correlating with lung recruitment. Similarly, its use in detecting pneumothorax and harmful patient-ventilator interactions such as pendelluft has been proven effective. Nonetheless, its impact on clinically meaningful outcomes remains to be determined. Electrical impedance tomography is a potential tool for the individualized management of ARDS throughout its different stages. Clinical trials should aim to determine whether a specific approach can improve clinical outcomes in ARDS management.

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Acute Respiratory Distress Syndrome Management in Pediatric Intensive Care Units in Turkey: A Prospective Survey.

Objective: This study aimed to explore the compliance of management strategies for pediatric acute respiratory distress syndrome in pediatric intensive care units in Turkey with current guidelines.Materials and Methods: This is a cross-sectional, prospective survey study. We delivered the survey, consisting of questions on topics in the relevant literature on acute respiratory distress syndrome management in children (1 month–18 years), to the heads/staff of the 100 units via email or phone. Results: In total, 51 (51%) out of 100 targeted pediatric intensive care units responded to the survey. We found out that 17 (33%) units comply with no acute respiratory distress syndrome guideline, while 65% frequently utilize cuffed endotracheal tubes. The majority of the units (86%) achieve their mechanical ventilation targets with the help of pressure control modes. Besides, steroid and surfactant use are present in 47% and 45% of the units, respectively, while 16% and 38% of the units use inhaled nitric oxide and high-frequency oscillatory ventilation, respectively. Conclusion: Lung-protective ventilation strategies preventing ventilator-associated lung injury are explicit in all responding units. The present survey revealed that current mechanical ventilation and non-ventilation treatment strategies in pediatric ARDS in Turkey are relatively uniform and largely consistent with international practices.

A New Approach of Several Minimally Invasive Procedures for Improvement of the Outcome in Preterm Infants

BACKGROUND: Based on the last update of European Consensus Guidelines on Management of Respiratory Distress Syndrome, the following study is new for our clinic approach for minimally invasive respiratory support in preterm infants. AIM: The aim is to find out if the implementation of several minimally invasive procedures leads to a reduction of the frequency and severity of chronic complications and improved outcomes in extremely premature infants. MATERIALS AND METHODS: Infants are below 30 gestational weeks, divided into two groups – therapeutic – 37 infants on standardized early respiratory management protocol which includes: High-flow continuous positive airway pressure (20l/min ≥ 15 PEEP) in the delivery room, support of spontaneous breathing and non-invasive mechanical ventilation, avoidance of hypothermia and LISA shortly after birth, and control group – 46 infants that received standard respiratory support (positive pressure ventilation – invasive and non-invasive in the delivery room, most infants ≤ 27 weeks gestational age were intubated and received early surfactant, extubation “when being ready” – usually after few days). RESULTS: The duration of mechanical ventilation, oxygen therapy, and hospital stay is shorter in the therapeutic group (p < 0.05). Severe bronchopulmonary dysplasia is not found in the interventional group, 26% of the patients in the control group have severe form of the disease (p = 0.001). Severe intraventricular hemorrhages are found in 11% of the infants in the therapeutic group and 28% in the control group (p = 0.06). CONCLUSION: Due to the changed protocol, we report increased survival of ELBW infants without severe chronic complications. The acute pulmonary injury, acquired in the perinatal period, is directly connected with the development of BPD. For this reason, all the changes that we introduced in our clinic (heat management, support of spontaneous breathing, “open up” lungs – high flow PEEP/CPAP, and LISA during spontaneous breathing) contribute to the lower frequency of severe chronic complications and high percentage of ELBW infants, who do not develop severe BPD.

Analytical Study of Different Modes of Continuous Positive Airway Pressure (CPAP) in Management of Respiratory Distress Syndrome (RDS) Preterm Neonates

Analytical Study of Different Modes of Continuous Positive Airway Pressure (CPAP) in Management of Respiratory Distress Syndrome (RDS) Preterm Neonates

Proning in COVID-19 Acute Respiratory Distress Syndrome: Role of Paralytics.

OBJECTIVES:Although proning is beneficial to acute respiratory distress syndrome, impressions vary about its efficacy. Some providers believe that paralysis is required to facilitate proning. We studied impact of paralysis on prone-induced gas exchange improvements and provider attitudes regarding paralytics.DESIGN:Observational.SETTING:University of California San Diego.PATIENTS:Intubated COVID acute respiratory distress syndrome patients.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:1) Changes in Pao2:Fio2 and Spo2:Fio2 ratios before and after proning with and without paralytics, 2) adverse events during proning with and without paralytics, and 3) nurse and physician attitudes about efficacy/safety of proning with and without paralytics. Gas-exchange improvement with proning was similar with and without paralytics (with no serious adverse events). Survey results showed similar attitudes between nurses and physicians about proning efficacy but differing attitudes about the need for paralytics with proning.CONCLUSIONS:Findings support use of proning and may help in design of randomized trials to assess paralytics in acute respiratory distress syndrome management.

Surfactant Utilization Evaluation in a Major Teaching Hospital in West of Iran: An Observational, Prospective Study

Background: The respiratory distress syndrome (RDS) is a common pulmonary disorder that usually occurs as a result of preterm labor and is associated with lack of surfactant. The aim of this study was to evaluate the pattern of surfactant prescription in Alzahra teaching hospital in Tabriz, Iran. Methods: This drug use evaluation (DUE) study was conducted in the neonatal intensive care unit (NICU) of Al-Zahra Hospital, Tabriz, Iran. The demographic and clinical data collection was performed using clinical records of patients. The pattern of surfactant replacement therapy was evaluated and compared with the European Consensus Guideline on the management of respiratory distress syndrome in 2016. Results: A total of 252 premature infants who received surfactant between August 2017 and March 2018 were included. 80.8% of neonates were born by cesarean section. The most used surfactant was Curosurf®, which was used in 82.1% of cases. Only 34.9% of the infants received within 8 hours of birth. Moreover, 79% of infants received the standard dose of surfactant, while 9.5 % and 11.5% were given high and low doses of surfactant, respectively. Conclusion: The pattern of surfactant replacement therapy was not completely according to the guidelines, particularly regarding the time of administration. Considering the importance of dose and timely administration of surfactant, providing strategies to decrease these errors are important.

Clinical outcome of preterm babies managed for respiratory distress syndrome using nasal continuous positive airway pressure and surfactant: An experience from Ile-Ife, South-Western Nigeria

Background: Respiratory distress syndrome (RDS) is a common cause of morbidity and mortality among preterm babies. It is caused by a deficiency of surfactant; hence, there is reduced lung compliance and increased work of breathing. The use of continuous positive airway pressure (CPAP) ventilation, a noninvasive form of ventilation, as well as the administration of exogenous surfactant, has proven to be very useful in the management of RDS. The use of less invasive techniques in ventilation and administration of surfactant have also been shown to reduce the risk of bronchopulmonary dysplasia and adverse effect of intubation. Objective: The objective is to determine mean oxygen saturation at 1 h, 6 h, and 12 h after commencement of CPAP, the mean values of FiO2 and positive end-expiratory pressure before and after administration of surfactant, and the overall case-fatality rate and birth weight-specific mortality rates. Methods: Study design was a prospective observational study and subjects were inborn babies between 26 and 34 weeks gestation who were managed for RDS with CPAP alone or with additional surfactant. Results: All 104 recruited preterm babies were managed with CPAP. Fifty-six (53.8%) babies also had surfactant administered. The mean weight of the babies was 1.35 (±0.322) kg, and the mean gestational age was 30.95 (±2.24) weeks. Extremely low birth weight (ELBW), very low birth weight (VLBW), and LBW constituted 11.5%, 55.8%, and 32.7% of the study population, respectively. The mean SPO2 before CPAP and 12 h after were 90.93 (±5.39) % and 96.5 (±3.30) %, respectively. The overall case-fatality rate was 18.2%, and birth-weight-specific mortality rates for ELBW, VLBW, and LBW were 58.3%, 15.5%, and 9.7%, respectively. Conclusion: From this study, it is clear that the prompt use of a cost-effective CPAP devices and the administration of surfactant are very effective in reducing morbidity and mortality among VLBW babies. While most local studies focused on the experience with the use of CPAP alone, this study goes further to demonstrate that the use of CPAP and surfactant is more effective in the management of RDS.

Management of Preterm Infants with Respiratory Distress Syndrome Using Non-Invasive High Frequency Ventilation versus Nasal Continuous Positive Airway Pressure

Background: Preterm infants have a risk of the respiratory distress syndrome (RDS). Helpful effects of high-frequency ventilators have been shown within management of RDS as well as the use of these ventilators as the initial mode of support or as a rescue treatment once failure of standard mechanical ventilation. Objective: This study aimed to compare between the nasal high-frequency oscillatory ventilation (nHFOV) and nasal continuous positive airway pressure (NCPAP) in the treatment of preterm infants with RDS in. Patients and methods: A study included 62 neonates with respiratory distress syndrome and was conducted at neonatal intensive care unit, Pediatrics Department, Zagazig University Hospital. Cases were divided into; group (A) was managed with non-invasive high frequency nasal ventilation and group (B) was managed with nasal continuous positive airway pressure. All cases were subjected to full medical history, clinical assessment, laboratory investigations and Silverman Score for respiratory distress grading. Results: There was statistically non-significant difference between the studied groups regarding occurrence of nasal injury, oxygen supply after study and need for use of surfactant. There was statistically non-significant difference between the studied groups regarding x ray findings before or by the end of the study. There was statistically significant relation between gestational age groups and need for surfactant in NHFV group. Conclusion: Noninvasive high frequency ventilation (NHFV) represent a better primary non-invasive mode than NCPAP in treatment of preterm infants with RDS.

Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines.

BackgroundLittle is known about the quality and potential impacts of the guidelines for coronavirus disease 2019 (COVID-19) management.MethodsWe systematically searched PubMed, Web of Science, Cochrane Library, guideline databases, and specialty society websites to evaluate the quality of the retrieved guidelines using the Appraisal of Guidelines for Research and Evaluation II.ResultsA total of 66 guidelines were identified. Only 24% were categorized as “recommended” for clinical practice. The 211 identified recommendations for COVID-19 management were classified into 4 topics: respiratory support (27), acute respiratory distress syndrome management (31), antiviral or immunomodulatory therapy (95), or other medicines (58). Only 63% and 56% of recommendations were supported by, respectively, assessment of the strength of the recommendations or level of evidence. There were notable discrepancies between the different guidelines regarding the recommendations on COVID-19 management.ConclusionsThe quality of the guidelines for COVID-19 management is heterogeneous, and the recommendations are rarely supported by evidence.

Short-term effects of synchronized vs. non-synchronized NIPPV in preterm infants: study protocol for an unmasked randomized crossover trial

BackgroundNon-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management has not yet been established.Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant’s breathing efforts.The aim of the study is to evaluate the short-term effects of SNIPPV vs. NIPPV on the cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support.MethodsAn unmasked randomized crossover study with three treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frames of 4 h each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining continuous assisted ventilation without patient discomfort.During the whole duration of the study, the patient’s cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer.The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are the number of the cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index, and thoracoabdominal asynchrony. The calculated sample size was of 30 patients.DiscussionIt is known that NIPPV produces a percentage of ineffective acts due to asynchronies between the ventilator and the infant’s breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation.Trial registrationClinicalTrials.gov NCT03289936. Registered on September 21, 2017.