RESUMEN
Objective: To compare the efficacy and safety of Nasal intermittent positive pressure ventilation (NIPPV) and Nasal continuous positive airway pressure (nCPAP) in neonates. Methods: Standard search strategy for the Cochrane Neonatal Review Group was performed. The participants were both preterm and term infants suffering from neonatal respiratory distress syndrome or experiencing apnea of prematurity. Results: 14 eligible andomized controlled trials involving 1052 newborn infants were included. The study quality and evidence validity was defined as moderate. As compared with nCPAP, NIPPV significantly reduced the incidence of endotracheal ventilation (OR=0.44, 95%CI:0.31–0.63), increased the successful rate of extubation (OR=0.15, 95%CI:0.08–0.31), and had a better outcome indicated by decreased death and/or bronchopulmonary dysplasia (OR=0.57, 95%CI:0.37–0.88). Moreover, NIPPV decreased the number of apneic episodes of prematurity (WMD=-0.48, 95%CI:-0.58–0.37), and marginally decreased the incidence of bronchopulmonary dysplasia (OR=0.63, 95%CI:0.39–1.00). No side effects specifically associated with NIPPV were reported. Conclusions: NIPPV could be used to reduce endotracheal ventilation, increase successful extubation, decrease the rate of apnea of prematurity, and have better outcome indicated by fewer death and/or bronchopulmonary dysplasia in preterm and term newborn infants.
RESUMEN
OBJECTIVE: To investigate the role of hemocoagulase to prevent pulmonary hemorrhage in critical newborns on mechanical ventilation. DESIGN: Randomized controlled trial. SETTING: Neonatal Intensive Care Unit of an affiliated hospital of a Medical University. CHILDREN: Seventy-two critical newborn infants on mechanical ventilation. INTERVENTION: The involved neonates were divided randomly into two groups. Forty-one patients were treated with prophylactic hemocoagulase(dripped through the endotracheal tube), and other 31 neonates served as controls. OUTCOME MEASURES: Incidence of pulmonary hemorrhage, time of ceasing pulmonary hemorrhage if occurred, time of withdrawing of mechanical ventilation in the survivors, and mortality. RESULTS: The incidence of pulmonary hemorrhage (12% vs 42%) and the time of ceasing pulmonary hemorrhage (1.36 +/- 0.65 vs 3.58 +/- 0.82, days), were significantly less in infants treated with prophylactic hemocoagulase as compared with the controls (P<0.05). The time to withdrawal of mechanical ventilation was less in the intervention group (3.20 +/- 0.45 vs 5.04 +/- 1.51 days) (P < 0.05). The mortality in children who received hemocoagulase was 22.0%, which was significantly less than controls (41.9 %) (P < 0.05). CONCLUSION: Prophylactic use of hemocoagulase in mechanically ventilated neonates is effective against pulmonary hemorrhage.