Nasal Intermittent Positive Pressure Ventilation Versus Nasal Continuous Positive Airway Pressure For Neonatal Respiratory Distress Syndrome:a Randomized,Controlled, Prospective Study

To compare the efficacy of nasal intermittent positive pressure ventilation(NIPPV) andnasal continuous positive airway pressure(NCPAP) in neonatal respiratory distress syndrome(NRDS).[Method]A randomized, controlled, prospective, single-center study was performed on neonateswith NRDS who were admitted in the neonatal intensive care unit(NICU) of the first affiliation hospital of Bengbu Medical College from March2011to February2012.The inclusion criteria included:(1)gestational age<37weeks.(2)neonates present with early respiratory distress comprising cyanosis, grunting, retractions, tachypnoea, developed respiratory failure and classical chest x-ray manifestation such as ground glass, air bronchograms and white lung.The exclusion criteria included:(1)severe congenital malformation, meconium aspiration and infection.(2)severe respiratory acidosis(PaCO2>60mmHg before the treatment of NIPPV or NCPAP).(3)the cases of unknown outcome.(4)infants did not need respiratory support or if parents refused consent.These neonates were randomized into NIPPV group and NCPAP group.The blood gas analysis, oxygenase index(OI), duration of respiratory support and complications were detected and recorded. The incidence of success, good outcome, bronchopulmonary dysplasia (BPD) and death were compared between the two groups.Measurement data are presented as mean±standard deviation and were compared using Student’s Mest or t’-test.Enumeration data were analyzed by chi-square test.All statistical analyses were performed using SPSS13.0for Windows.P<0.05was considered statistically significant.[Results]1.General conditions:The enrolled patients were32in NIPPV group and30in NCPAP group.There were no significant differences in the gender, gestational age, birth weight, Apgar score at5minutes, score for neonatal acute phyiology, perinatal extension, version Ⅱ (SNAPPE-Ⅱ), the rate of using pulmonary surfactant or blood gas analysis and oxygenase index before the treatment of non-invasive ventilation between the two groups(P>0.05, respectively).2.Comparison of efficacy(1)blood gas analysis and OI:The blood gas analysis showed that PaO2and OI in NIPPV group were significantly higher than those in NCPAP group1hour after the treatment of non-invasive ventilation (P<0.05, respectively)(2)The success rate and duration of respiratory support:More infants did not need endotracheal ventilation when they were treated initially with NIPPV compared with those treated with NCPAP(68.8%vs40.0%, P<0.05).The duration of nasal respiratory support or mechanical ventilation via endotracheal tube were comparable between the two groups(P>0.05, respectively).3.Comparison of complications:Three infants had pneumothorax,1in the NIPPV group and2in the NCPAP group; both occurred on mechanical ventilation via endotracheal tube.Compared with NCPAP, NIPPV did not increase the incidence of pneumothorax (3.1%vs6.7%, P>0.05).4.Comparison of prognosis:As compared with NCPAP,NIPPV did not improve the incidence of good prognosis and there was no significant reduction in the incidence of BPD or death(P<0.05, respectively). Compared with NCPAP, NIPPV could decrease the requirement for endotrachealventilation in premature infants with NRDS.However, there was no evidence supporting that NIPPV could reduce the incidence of BPD or death.Larger sample size RCTs are needed to investigate the long-term efficacy of NIPPV in premature infants withNRDS.