Nasal high frequency percussive ventilation versus nasal continuous positive airway pressure in transient tachypnea of the newborn: A pilot randomized controlled trial (NCT00556738)

Abstract

Objective To determine whether nasal high frequency percussive ventilation (NHFPV) would decrease duration of transient tachypnea of the newborn (TTN) compared to nasal continuous positive airway pressure (NCPAP) in newborn infants. Methods A prospective, unmasked, randomized, controlled clinical trial was conducted in 46 eligible newborn infants who were hospitalized for TTN in the University Hospital of Bordeaux (France) between 2007 and 2009. Infants born by cesarian section ≥37 GA, ≥2,000g with diagnosis of TTN and with a transcutaneous saturation <90% at 20 min after birth were eligible. Infants were randomized to either NHFPV or NCPAP. The primary endpoint was a reduction of the duration of TTN. Secondary endpoints were the duration of oxygen therapy and the minimal level required to obtain a saturation between 90% and 96% integrated into an index which included a time factor: [(FiO2—21)/time of O2 therapy]. Results In the NHFPV group the duration of TTN was half the time of NCPAP group (105 min ± 20 and 377 min ± 150, respectively; P < 0.0001). There was a significant decrease in duration of oxygen supplementation in the NHFPV group (6.3 min ± 3.3) compared to the NCPAP group (19.1 min ± 8.1; P < 0.001), and a significant decrease in level of oxygen supplementation [(FiO2—0.21)/time of O2 therapy] in the NHFPV group (0.29 min−1 ± 0.16) compared to the NCPAP group (0.46 min−1 ± 0.50; P < 0.001). There was no complication and NHFPV was as well tolerated as NCPAP. Conclusion NHFPV is well tolerated and more effective than NCPAP in treatment of TTN. NHFPV might be a novel and safe tool to manage TTN. Pediatr Pulmonol. 2011; 46:218–223. © 2011 Wiley‐Liss, Inc.

Nasal High-Frequency Oscillation for Lung Carbon Dioxide Clearance in the Newborn

“…It has all the benefits of NIPPV with the added advantage of not being as dependent on breath synchronization, something that can presently be difficult to achieve with NIPPV [9]. Limited studies on the clinical use of nHFO in neonates are available, [11,12,13] and the existing data do not adequately address CO 2 elimination efficacy. All available clinical studies of nHFO have reported on blood PCO 2 comparative changes pre and post initiation of this treatment modality [11,12].…”

“…Its use also does not require synchronization of breaths as the patient can comfortably continue normal tidal breathing while on the ventilator and thus has the potential to provide superior noninvasive ventilation. Only a limited number of clinical studies have explored the use of noninvasive high-frequency ventilation but whether this strategy is able to support adequate gas exchange in neonates has not been thoroughly addressed [11,12,13]. …”

Neonatal Noninvasive Ventilation Techniques: Do We Really Need to Intubate?

“…Dumas de la Roque et al 82 performed a prospective RCT of nasal CPAP versus nasal HFV in 40 term neonates with respiratory distress shortly after cesarean section. This was the first short-term prospective study to describe nasal HFV as an initial form of noninvasive respiratory support The gestation control fetal lambs were (1) delivered at the gestation age that the preterm lambs were delivered (FA132) or (2) delivered at the gestation age when the preterm lamb studies were completed (FA136).…”

Transient tachypnea of the newborn: are there bedside clues for predicting the need of ventilation support?

“…TTN is generally a benign disease and treated with a brief course of oxygen. However, some of the cases need invasive or non-invasive respiratory support 6,7,11,12 .…”