Noninvasive ventilation for RDS in preterm infants

Abstract from Port Said Seventh Neonatology Conference, October 2016

Prof  Nesrin Handoka,   

Associate professor of pediatrics, Head of pediatric departmeimg_7164nt, Port said university


Introduction: Respiratory distress syndrome (RDS) is the most common respiratory morbidity in preterm infants. Invasive mechanical ventilation through the endotracheal tube (ETT) has been the cornerstone in RDS management, resulting in airway and lung injury and contributing to the development of bronchopulmonary dysplasia (BPD) and adverse neurodevelopmental. In an attempt to reduce lung injury, Noninvasive Ventilation (NIV) has been used for the past 3 decades; moreover, synchronized nasal intermittent positive-pressure ventilation (SNIPPV) has been increasingly used in preterm infants in an attempt to decrease ETT complications.

Objective: to compare the outcomes of preterm infants with RDS treated with SNIPPV to infant treated with endotracheal tube positive-pressure ventilation (ETTPPV).

Patients and methods: The study included 52 preterm neonates with RDS randomly divided into 2 groups, 25 patients (48%) of them treated by ETTPPV as group (A) and 27 patients (52%) on SNIPPV as group (B) as a primary respiratory support, with birth weights (BW) less than 1500 g. All patients were subjected to detailed history taking, full clinical examination and investigations including; chest x-ray, complete blood count, CRP and arterial blood gases.

Results: The mean gestational age was 32.8±0.7 weeks, and the mean birth weight was 1.214±0.124 kg in ETTPPV group, and the mean gestational age of (32.9±0.6) weeks, and the mean birth weight of (1.280±0.110) kg in SNIPPV group. There were no significant differences in gestational age, gender, BW, mode of delivery, surfactant use, antenatal steroid use, or Apgar at 1& 5 min between both groups. SNIPPV group had a statistically significant shorter duration of ventilation, duration of oxygenation and duration of hospital stay than ETTPPV group.  There was 3/27 patients (11%) had ventilation failure in SNIPPV group, and 4/25 patients (16%) need re-intubation after extubation in ETTPPV group. Neonates in the ETTPPV group had significantly more complications compared to the SNIPPV group (44% versus 34%); there is higher mortality (12%) in ETTPPV group compared to NIPPV (4%).

Conclusion: The use of SNIPPV as primary respiratory support is beneficial in reduction of mortality and morbidities like pneumothorax, NEC, and BPD.