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

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: