Comparison Of Three Non-Invasive Ventilation Strategies For RDS As The Primary Therapy In Preterm Infants Born At Less Than 32 Weeks' Gestation

Objective To compare the clinical efficacy of three non-invasive ventilation strategies(NIPPV/Bi-PAP/NCPAP)as primary therapy for neonatal respiratory distress syndrome(NRDS)in preterm infants born at less than 32 weeks,of gestational age.Methods A prospective randomized control study was conducted in the first affiliated hospital NICU of Anhui medical university from august 2017 to January 2019.preterm infants born at less than 32 weeks of gestational age with RDS were enrolled in the study.According to differences of the initial non-invasive ventilation(NIV)strategies,the infants were divided into three groups(NIPPV ? Bi-PAP ? NCPAP).the efficacy of different NIV strategies were evaluated by primary outcome(failure within the first5 days of life),and some secondary end-points(requiring pulmonary surfactant,duration of non-invasive ventilation,and incidence of complication,length of hospital stay,et al).Results(1)According to inclusion and exclusion criterion,97 preterm infants were enrolled in this research(NCPAP,n=36;NIPPV,n=30;Bi-PAP,n=31).(2)The rates of mechanical ventilation in three group(NCPAP,r=28.57%;NIPPV,r=7.14%;Bi-PAP,r=9.68%)were different,and the difference was statistically significant(p<0.05).compared to NCPAP group,Bi-PAP group had the lower rate of mechanical ventilation(P=0.048);compared to NCPAP group,NIPPV group similarly had the lower rate of mechanical ventilation(p=0.021).but compared Bi-PAP with NIPPV group,the rate of MV had no obvious difference(P=0.694).(3)There were not significant differences in the incidence of mortality rate,the time of NIV,the length of hospital stay,the PS usage and complications(BPD,PNX,NEC,BPD,ROP,IVH,PDA and LOS)between the three groups(P>0.05).Conclusions This study indicates NIPPV/Bi-PAP as the primary treatment for RDS have the beneficial effects of NCPAP contributing to a reduced risk of failure in infants born at less than 32 weeks of gestational age,but have not decreasing the use of PS and complications.The relevant results need further RCT research.