ABSTRACT
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
ABSTRACT
Respiratory distress syndrome [RDS] is one of the most common causes of morbidity and mortality in preterm neonates, and is caused by surfactant deficiency. Among different strategies for treatment of RDS, the INSURE method [Intubation, Surfactant, Extubation to NCPAP] has some advantages over the mechanical ventilation with surfactants administration. This study was conducted to determine the efficacy of INSURE method in NICU of Mahdieh Hospital, during 2007-8. In this study, 66 preterm infant with gestational age of 25 to 32 weeks and birth weight of 600 to 1500 gram who had clinical sign of moderate to server RDS were included. These infants received surfactant by INSURE method [surfactants administration via endotracheal tube during 2-3 min and then extubation to NPCPAP]. INSURE success rate was 60.6% and proved to be gestational age [p=0.019] and birth weight [p<0.001] dependent. In the INSURE success group, the need for second dose of surfactant [p<0.001], mean duration of hospital stay [p=0.035], complication of disease [p<0.001] and death [p<0.001] were less than the INSURE failure group. However no significant difference in gender, method of delivery, parity and age of surfactants administration were seen among the groups. The INSURE method reduces the use of mechanical ventilation, complications, duration of hospital stay and death in neonates with RDS