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Nasal CPAP vs Bi-level Nasal CPAP in Preterms With RDS: a randomized control study
  1. Gianluca Lista1,*,
  2. Francesca Castoldi1,
  3. Paola Fontana1,
  4. Irene Daniele1,
  5. Francesco Cavigioli1,
  6. Samantha Rossi1,
  7. Roberta Reali2
  1. 1 NICU, V.Buzzi Children's Hospital, ICP, Milan, Italy;
  2. 2 Laboratory, V.Buzzi Children's Hospital, ICP, Milan, Italy
  1. Correspondence to: gianluca lista, NICU, Ospedale dei Bambini "V.Buzzi", via castelvetro 32, milano, 20154, Italy; g.lista{at}


Objective: to evaluate the clinical course, respiratory outcomes and markers of inflammation in preterm infants with moderate respiratory distress syndrome assigned from birth to Nasal Continuous Positive Airway Pressure (NCPAP) or Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP).

Study design: 40 infants of 28-34 weeks GA (<35 wks GA), affected by moderate RDS, were considered eligible and were randomized to NCPAP (CPAP level=6 cmH2O, Group A n=20) or to Bi-level NCPAP (lower CPAP level=4.5 cmH2O; higher CPAP level=8 cmH2O, Group B n=20), provided with the variable flow devices (Infant Flow CPAP vs Infant Flow SiPAP™, Viasys Healthcare, Yorba Linda, CA).

Main outcome measures: Inflammatory response was the primary outcome; serum cytokines were measured on days 1 and 7 of life. Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as secondary outcomes.

Results: Infants showed similar characteristics at birth (GrA vs GrB: GA 30.3 2 versus 30.2 2wks, BW 1429 545 versus 1411 560g) and showed similar serum cytokine levels at all times. GrA underwent longer respiratory support (6,2 2 days versus 3,8 1 days, p=0.025), longer O2 dependency (13,8 8 days versus 6,5 4 days, p=0.027) and was discharged later (GA at discharge 36,7 2,5 weeks versus 35,6 1,2 weeks, p=0.02). All infants survived. No BPD or neurological disorders occurred.

Conclusions: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. In our population it was well tolerated and safe.

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