Nasal CPAP vs Bi-level Nasal CPAP in preterms with RDS: a randomized control study

Authors

  • Vivek Arora Department of Pediatrics, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India
  • Sandip G Gediya Department of Pediatrics, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India http://orcid.org/0000-0001-6995-8055
  • Shaitan Singh Balai Department of Pediatrics, Rabindranath Tagore Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20171710

Keywords:

Bi-level nasal continuous positive airway pressure, Nasal continuous positive airway pressure, Neonate, Respiratory distress syndrome, Respiratory outcome, Ventilation

Abstract

Background: Ventilator induced lung injury prevention may begin from birth, and respiratory support without endotracheal intubation is an attractive option in preterm baby with Respiratory distress syndrome (RDS). The objective of the study was to evaluate the clinical course and respiratory outcomes in preterm infants with moderate RDS assigned from birth to Nasal Continuous Positive Airway Pressure (NCPAP) or Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP).

Methods: 60 infants of 28-34 weeks GA (<35 wks GA), affected by moderate RDS, were considered eligible and were randomized to NCPAP (CPAP level=6cm H2O, Group A n=30) or to Bi-level NCPAP (lower CPAP level=4.5 cmH2O; higher CPAP level=8 cmH2O, Group B n=30), provided with the variable flow devices (Infant Flow CPAP vs Infant Flow SiPAP™, Viasys Healthcare, Yorba Linda, CA).

Results: Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as outcomes. Infants showed similar characteristics at birth (Group A versus Group B: GA 30.4±2 wks versus 30.3±2wks, BW 1433±545g versus 1415±560g. Group A underwent longer respiratory support (6,2±2 days versus 3,8±1 days, p=0.025), longer O2 dependency (13,8±8 days versus 6,5±4 days, p=0.027) and was discharged later (GA at discharge 36,7±2,5 weeks versus 35,6±1,2 weeks, p=0.02). All infants survived. No BPD or neurological disorders occurred.

Conclusions: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. In our population, it was well tolerated and safe

References

Davis PG, Henderson-Smart DJ. NCPAP immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev. 2003;(2):CD000143.

Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev. 2005;(3):CD001243.

Morley CJ, Davis PG, Doyle LW. For the COIN Trial Investigators Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008; 358:700-8.

Ho JJ, Henderson-Smart DJ, Davis PG. Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. 2002;(2):CD002975.

Migliori C, Motta M, Angeli A. Nasal bi-level vs continuous positive airway pressure in preterm infants. Pediatr Pulmonol. 2005;40(5):426-30.

Chow LC, Wright KW and Sola A. Can Changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics. 2003;111:339-45.

Sandri F, Plavka R, Simeoni U. The CURPAP Study: an international European randomized controlled trial to evacuate the efficacy of combining prophylactic surfactant and early nasal continuous positive airway pressure in very preterm infants. Neonatology. 2008;94:60-2.

Bisceglia M, Belcastro A, Poerio V. A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants. Minerva Pediatrica. 2007;59:91-5.

Sherry E. Courtney MD, Keith J. Barrington MD. Continuous positive airway pressure and non-invasive ventilation. Clin Perinatol. 2007;34:73-92.

De Paoli AG, Davis PG, Faber B. Devices and pressure source for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates (review). Cochrane Database Syst Rev. 2008;23;(1):CD002977.

Owen LS, Morley CJ, Davis PG. Neonatal nasal intermittent positive pressure ventilation: what do we know in 2007? Review Arch Dis Child Fetal Neonatal Ed. 2007;92:414-8.

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Published

2017-04-25

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Original Research Articles