Noninvasive Ventilation Strategies for Early Treatment of RDS in Preterm Infants: An RCT

Abstract

BACKGROUND AND OBJECTIVES: There is evidence that new methods of noninvasive ventilation (NIV) support have significantly changed respiratory distress syndrome (RDS) management in preterm infants. Further perspectives for neonatologists involve the assessment of different NIV strategies in terms of availability, effectiveness, and failure. This study evaluates the efficacy of 2 different NIV strategies for RDS treatment in very low birth weight (VLBW) infants: nasal synchronized intermittent positive pressure ventilation (NSIPPV), which is a modality of conventional ventilation with intermittent peak inspiratory pressure, and bilevel continuous positive airway pressure (BiPAP), not synchronized, with 2 alternate levels of continuous positive airway pressure. METHODS:We conducted a 2-center randomized control study in 124 VLBW infants (,1500 g and ,32 weeks of gestational age) with RDS who received NIV support (NSIPPV, n = 62; BiPAP, n = 62) within 2 hours of birth. We evaluated the performance of NIV strategies by selected primary outcomes (failure rate and duration of ventilation) and secondary outcomes. RESULTS:The number of failures and duration of ventilation support did not differ between NSIPPV and BiPAP strategies (P . .05 for both). Moreover, no differences between groups were found regarding secondary outcomes (P . .05 for all).CONCLUSIONS: The present data show no statistically significant differences between NSIPPV and BiPAP strategies in terms of duration of ventilation and failures, suggesting that both NIV techniques are effective in the early treatment of RDS in VLBW infants. Further randomized investigations on wider populations are needed to evaluate the effect of NIV techniques on long-term outcomes.

Efficacy of noninvasive respiratory support modes for primary respiratory support in preterm neonates with respiratory distress syndrome: Systematic review and network meta‐analysis

“…Most of the evidence that contributed to this comparison was indirect and there was only a single RCT that had compared these two interventions. 57 Millar et al 75 High quality-very confident that the true effect lies close to that of the estimate of the effect. Moderate quality-moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.…”

“…Overall, 13 studies 25,28,30,32,33,37,[40][41][42][43][44]51,57 were regarded as having a low risk of bias, the remaining studies were found to have variable degrees of risk of bias. Fourteen studies had high risk of bias 27,[34][35][36]38,45,[47][48][49][50]52,[54][55][56] with issues in randomisation and/or allocation concealment.…”

Comparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial

“…Advances in neonatal intensive care and mechanical ventilation of newborns have increased infants’ survival during recent years and was subject of many recent investigations ( Donn et al, 2003 ; Wu et al, 2015 ; Armanian et al, 2014 ; Salvo et al, 2015 ; Chu et al, 2015 ; Akinloye et al, 2014 ; Schmölzer et al, 2014 ). New ventilation methods and techniques that have newly become available have made the mechanical ventilation in neonates a masterpiece in the twenty-first century ( Keszler, 2006 ).…”

A comparison of the effect of bi-level positive airway pressure and synchronized intermittent mandatory ventilation in preterm infants with respiratory distress syndrome

“…Previous studies have reported the effects of some modes of ventilation in the treatment of RDS in prematurity, such as BiPAP vs nasal synchronized intermittent positive pressure ventilation (NSIPPV) 9 ; nasal bi-level PAP (N-BiPAP) vs sigh-PAP (n-SiPAP) 10 ; and nasal intermittent positive pressure ventilation (NIPPV) vs nasal continuous positive airway pressure (NCPAP) 11 . This is the first report to compare normal-frequencyassisted ventilation for preterm infants ([?]…”