Continuous Positive Airway Pressure for Spontaneously Breathing Premature Infants with Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is a life-threatening pulmonary disorder which mainly related to the premature infants. This study was conducted to evaluate Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Cannula (HFNC) intervention effectiveness among premature infants with RDS. Methods Overall, 60 preterm infants with RDS at Valiasr Hospital, Tehran, during 2018 in this randomized control trail participated as CPAP and HFNC groups’ treatment. CPAP group received the nose with a peep of 4-6 centimeters from birth and continued to improve respiratory distress and the need for oxygen (O2). HFNC group received hot and humid flowing 2 to 5 liters/min in nose cannula, until respiratory distress and O2 needing to be resolved. Short clinical outcomes were compared between two groups. Data were analyzed by SPSS version 16 using t-test and logistic regression statistical tests at 95% significant level. Results There were no significant differences in Pneumothorax, PDA, chronic lung disease, surfactant injection, tracheal intubation, death, NEC, number of full feeding days, duration of hospitalization, and number of oxygen therapy days between the both CPAP and HFNC groups. Conclusions CPAP and HFNC techniques have the same efficacy in confronting RDS in neonates and there is no difference between the two techniques in terms of in-hospital clinical outcomes. However, considering the same efficacy of two methods and less invasive of HFNC compared with CPAP, we concluded this method can be recommended for the improvement of respiratory distress in newborns. Trial Registration Iranian Registry of Clinical Trials identifier IRCT20190623043988N1 Registered 2019-07-05.

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Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02741-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arash Malakian ◽

Mohammad Reza Aramesh ◽

Mina Agahin ◽

Masoud Dehdashtian

Keyword(s):

Mechanical Ventilation ◽

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Abstract Background The 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. Methods 148 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. Results there 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). Conclusions In 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 registration IRCT20180821040847N1, Approved on 2018-09-10.

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Cost-saving effect of early less invasive surfactant administration versus continuous positive airway pressure therapy alone for preterm infants with respiratory distress syndrome

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2020-002465 ◽

2021 ◽

pp. ejhpharm-2020-002465

Author(s):

Carlo Federici ◽

Giulia Fornaro ◽

Charles Christopher Roehr

Keyword(s):

Continuous Positive Airway Pressure ◽

Cost Saving ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Pressure Therapy ◽

Surfactant Administration ◽

Saving Effect

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Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

Neonatology ◽

10.1159/000514637 ◽

2021 ◽

Vol 118 (3) ◽

pp. 264-273

Author(s):

Anne Lee Solevåg ◽

Po-Yin Cheung ◽

Georg M. Schmölzer

Keyword(s):

Systematic Review ◽

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Premature Infants ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

Background: Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) use pressure settings ≥ those used during mechanical ventilation (MV), and biphasic continuous positive airway pressure (BiPAP) use two nasal continuous positive airway pressure (NCPAP) levels ≤4 cm H2O apart. Methods: A systematic review (Medline OVID and Pubmed) and meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) and mortality. Secondary outcomes included NIV failure (intubation) and extubation failure (re-intubation). Data were pooled using a fixed-effects model to calculate the relative risk (RR) with 95% confidence interval (CI) between NIV modes (RevMan v 5.3, Copenhagen, Denmark). Results: Twenty-four randomized controlled trials that largely did not correct for mean airway pressure (MAP) and used outdated ventilators were included. Compared with NCPAP, both nsNIPPV and SNIPPV resulted in less re-intubation (RR 0.88 with 95% CI (0.80, 0.97) and RR 0.20 (0.10, 0.38), respectively) and BPD (RR 0.69 (0.49, 0.97) and RR 0.51 (0.29, 0.88), respectively). nsNIPPV also resulted in less intubation (RR 0.57 (0.45, 0.73) versus NCPAP, with no difference in mortality. One study showed less intubation in BiPAP versus NCPAP. Conclusions: Bi-level NIV versus NCPAP may reduce MV and BPD in premature infants with RDS. Studies comparing equivalent MAP utilizing currently available machines are needed.

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