Management of neonatal respiratory distress syndrome employing ACoRN respiratory sequence protocol versus early nasal continuous positive airway pressure protocol

Respiratory distress syndrome [RDS] is a common cause of respiratory distress in premature infants. This study was designed to evaluate two different RDS treatment protocols by comparing the outcomes. This study was a double center cross sectional study performed from June to December 2012. During that period, 386 neonates with RDS were hospitalized and treated according to two different therapeutic protocols so-called Acute Care of at-Risk Newborns [ACoRN] respiratory sequence protocol [group I] and Early Nasal Continuous Positive Airway Pressure [E-NCPAP] protocol [group II]. The variables and main outcomes of this study were gestational age, birth weight, bronchopulmonary dysplasia [BPD], pulmonary hemorrhage [PH], intraventricular hemorrhage [IVH], air leak and mortality rate [MR]. Out of 386 infants, 202 infants were in group I [male 60.4%, female 39.6%, mean gestational age 316/7 weeks, mean birth weight=1688 grams] and group II included 184 infants [male 61.4%, female 38.6%, mean gestational age 32 weeks, mean birth weight 1787 grams], P= 0.07. The ratios of BPD of group I to group II and PH of group I to group two were not significant [P=0.6 and P=0.8, respectively]. Air leak ratio in group I was higher than in group II [P=0.001]. Although IVH ratio in group II was higher than in group I [P=0.01], grade III and IV IVH was higher in group I [30% vs. 4.6%]. In case of MR, it was higher in group I than in group II [P=0.001]. According to the findings the incidence of air leak, grade III and IV IVH and MR was less common in E-NCPAP protocol, so it may show the effectiveness of this protocol. The authors suggest that more researches are needed for more accurate results

Nasal intermittent positive pressure ventilation vs. nasal continuous positive airway pressure in preterm infants with respiratory distress

The trend today is to minimize the use of mechanical ventilation. Nasal continuous positive airway pressure [NCPAP] and nasal intermittent positive pressure ventilation [NIPPV] are 2 non-invasive treatments for respiratory distress syndrome [RDS]. There is little study in literature comparing early use of NIPPV with NCPAP as primary modes of respiratory support. The aim of this study is to determine whether NIPPV and NCPAP would have different survival rates and possible complications. In this prospective clinical trial study, 120 preterm neonates [gestational age 28-36 weeks] who were admitted due to respiratory distress between January and May 2012 in the neonatal intensive care unit of Afzalipour hospital. Sixty infants were randomized to NCPAP and comparable infants to NIPPV [birth weight 1807.05 +/- 52 vs. 1882.50 +/- 56 g, gestational age 32.05 +/- 2.94 vs. 32.16 +/- 2.08 weeks, respectively]. Patients were randomly allocated into 2 treatment groups using minimization technique. One group was treated by NCPAP and the second one treated by NIPPV. Survival analysis was applied to estimate and compare survival rates. Infants treated initially with NIPPV needed less endotracheal ventilation than infants treated with NCPAP [13.3% vs. 41.7%, p=0.001]. Estimated survival rates at 24 h in NIPPV were 97% versus 82% for NCPAP group. We have seen that the risk of failure for those received NCPAP was nearly 4 times higher than NIPPV group. According to our results, among preterm infants with suspected [RDS], the use of NIPPV reduces the need for intubation and mechanical ventilation in comparison to NCPAP

Bubble-CPAP vs. ventilatory-CPAP in preterm infants with respiratory distress

Application of Continuous Positive Airway Pressure [CPAP] in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP [B-CPAP] and ventilator-derived CPAP [V-CPAP] are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications. This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr who were admitted to the neonatal intensive care unit of Afzalipoor Hospital because of respiratory distress between June 2009 and May 2010. Patients were randomly allocated into treatment groups using minimization technique. Survival analysis was applied to estimate and compare survival rates. Duration of oxygen therapy, hospital stay as well as hospitalization costs were compared using independent sample t-test. Estimated survival rates at 24 hours in B-CPAP and V-CPAP groups were 100% and 77% respectively. Corresponding figures at 48 hours were 100% and 71%. In addition the hospitalization cost in V-CPAP group was significantly higher than in B-CPAP group. According to our results, B-CPAP was effective in the treatment of neonates who were suffering from respiratory distress and reduced the duration of hospital stay. In addition to mentioned benefits, its low cost may be the reason to use B-CPAP broadly compared with V-CPAP