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A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS

Abstract

Objective:

Comparison of outcomes of infants with respiratory distress syndrome (RDS), post-surfactant, extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV).

Study Design:

Prospective post-surfactant randomized controlled trial of primary mode SNIPPV compared with CV in infants (born from July 2000 to March 2005) with birth weights (BW) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS, following the administration of the first dose of surfactant.

Result:

There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, BW, gestational age, gender or Apgar at 5 min between infants continued on CV (n=21) and those extubated to primary mode SNIPPV (n=20). Significantly, more babies in the CV group had the primary outcome of bronchopulmonary dysplasia (BPD)/death, compared to the SNIPPV group (52 versus 20%, P=0.03). There was no difference in the incidence of other common neonatal morbidities. There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups.

Conclusion:

Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death. Primary mode SNIPPV is a feasible method of ventilation in small premature infants.

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Acknowledgements

We thank the other attending neonatologists at AEMC and YNHCH for their support of the study. We also thank Pat Gettner, RN, Joanne Poulson, RN and Monica Konstantino, RN at YNHCH for help with patient enrollment and data collection. Finally, we are grateful to the many nurses and respiratory therapists at the two sites for their support, as well to the parents who consented for the study. VB was supported by the Einstein Society (Grant no. 01-01) and the Curosurf Study Grant Program (Dey Inc.). RGG was supported by the Advancing Newborn Medicine Grant Program (Forest Laboratories). JHN was supported by T32 HD-07049 from the NICHD of the National Institutes of Health, USA.

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Bhandari, V., Gavino, R., Nedrelow, J. et al. A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS. J Perinatol 27, 697–703 (2007). https://doi.org/10.1038/sj.jp.7211805

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