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Objective: To determine effect of Premature Infant Oral Motor Intervention program on oro-motor function and time to full independent wati spoon feeds in preterm infants. Methods: 30preterm infants between 28-32 weeks of gestation on full gavage feeds of 150 mL/kg/daywere randomized to receive either pre-feed oro-motor stimulation using Premature InfantOral Motor Intervention (structured stimulation) or sham intervention (unstructuredstimulation). Results: Improvement in mean (SD) Neonatal Oro-Motor Assessment Scale(NOMAS) over 7 days from baseline was significantly higher in the study group infants ascompared to control group (9.25 (1.73) vs 4.79 (1.52), P=0.001). Infants in the study groupreached full independent wati spoon feeds significantly earlier than the infants in controlgroup (4.0 (0.8) d; vs 6.64 (1.0) d; P=0.001). There was significant increase in weight gainafter enrolment in infants in study group compared to those in control group. Conclusions:Oral stimulation program improves the oro-motor skills and growth velocity in 28-32 weekpreterm infants. There is decreased transition time from gavage to full independent feeds bymouth
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Objective: To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support. Study Design: Prospective observational cohort study Setting : Tertiary care level III neonatal intensive care unit Participants : 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth. Intervention: Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula (n=46) or Nasal Continuous Positive Airway Pressure (n=42). Primary outcome : Need for mechanical ventilation within 72 hrs of initiating support. Results: Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD – 0.74 (95% CI 0.34-1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) (P= 0.004). Conclusion: Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.
RESUMO
Objective: To compare the effectiveness of nasal continuous positive airway pressure delivered by Nasal mask vs Nasal prongs with respect to continuous positive airway pressure failure. Study design: Randomized, controlled, open label, trial. Setting: Tertiary care level III neonatal unit. Participants: 118 preterm infants-gestational age (27-34 weeks) requiring nasal continuous positive airway pressure as a primary mode for respiratory distress, who were treated with either nasal mask (n=61) or nasal prongs (n=57) as interface. Primary outcome: Need for mechanical ventilation within 72 h of initiating support. Results: Nasal continuous positive airway pressure failure occurred in 8 (13%) of Mask group and 14 (25%) of Prongs group but was statistically not significant (RR 0.53, 95% CI 0.24-1.17) (P = 0.15). The rate of pulmonary interstitial emphysema was significantly less in the Mask group (4.9% vs. 17.5%; RR 0.28, 95% CI 0.08-0.96; P = 0.03). Incidence of moderate nasal trauma (6.5% vs 21%) (P=0.03) and overall nasal trauma (36% vs 58%) (P=0.02) were significantly lower in mask group than in the prongs group. Conclusion: Nasal continuous positive airway pressure with mask as interface is as effective as prongs but causes less nasal trauma and pulmonary interstitial emphysema.