Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome
Article first published online: 12 JUN 2009
© 2009 The Author(s)/Journal Compilation © 2009 Foundation Acta Pædiatrica
Volume 98, Issue 9, pages 1412–1415, September 2009
How to Cite
Sai Sunil Kishore, M., Dutta, S. and Kumar, P. (2009), Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatrica, 98: 1412–1415. doi: 10.1111/j.1651-2227.2009.01348.x
- Issue published online: 27 JUL 2009
- Article first published online: 12 JUN 2009
- Received 28 November 2008; revised 21 February 2009; accepted 17 April 2009.
- Nasal intermittent positive pressure ventilation;
- Respiratory distress syndrome
Aim: To determine whether early nasal intermittent positive pressure ventilation (NIPPV), in comparison to early continuous positive airway pressure (CPAP), can reduce the need for intubation and mechanical ventilation in preterm neonates with suspected respiratory distress syndrome (RDS).
Methods: In this stratified open-label randomized controlled trial, neonates (28–34 weeks gestation) with respiratory distress within 6 h of birth and Downe's score ≥ 4 were eligible. Subjects were randomly allocated to ‘early-NIPPV’ or ‘early-CPAP’ after stratifying for gestation (28–30 weeks, 31–34 weeks) and surfactant use. Primary outcome was failure of the allocated mode within 48 h.
Results: Seventy-six neonates were enrolled (37 in ‘early-NIPPV’ and 39 in ‘early-CPAP’ groups). Failure rate was less with ‘early-NIPPV’ versus ‘early-CPAP’[13.5% vs. 35.9%, respectively, RR 0.38 (95% CI 0.15–0.89), p = 0.024]. Similarly, need for intubation and mechanical ventilation by 7 days (18.9% vs. 41%, p = 0.036) was less with NIPPV. Failure rate with NIPPV was less in the subgroups of subjects born at 28–30 weeks (p = 0.023) and who did not receive surfactant (p = 0.018).
Conclusion: Among preterm infants with suspected RDS, early use of NIPPV reduces the need for intubation and mechanical ventilation compared to CPAP.