Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks' gestation: A randomized, controlled trial

R. Ramanathan, K. C. Sekar, M. Rasmussen, Jatinder J Bhatia, R. F. Soll

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants 30 weeks gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery. Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV. Result: A total of 40% of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12 ± 11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P = 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P = 0.001). There were no differences in any other outcomes between the two groups. Conclusion: NIPPV compared with NCPAP reduced the need for MVET in the first week, duration of MVET, and clinical as well as physiological BPD in preterm infants receiving early surfactant for RDS.

Original languageEnglish (US)
Pages (from-to)336-343
Number of pages8
JournalJournal of Perinatology
Volume32
Issue number5
DOIs
StatePublished - May 1 2012

Fingerprint

Intermittent Positive-Pressure Ventilation
Continuous Positive Airway Pressure
Nose
Premature Infants
Surface-Active Agents
Randomized Controlled Trials
Artificial Respiration
Pregnancy
Bronchopulmonary Dysplasia
Therapeutics
Parturition
Intubation
Multicenter Studies

Keywords

  • NCPAP
  • NIPPV
  • bronchopulmonary dysplasia
  • preterm
  • respiratory distress syndrome
  • surfactant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks' gestation : A randomized, controlled trial. / Ramanathan, R.; Sekar, K. C.; Rasmussen, M.; Bhatia, Jatinder J; Soll, R. F.

In: Journal of Perinatology, Vol. 32, No. 5, 01.05.2012, p. 336-343.

Research output: Contribution to journalArticle

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abstract = "Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants 30 weeks gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery. Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV. Result: A total of 40{\%} of infants needed MVET at 7 days of age in the NCPAP group compared with 17{\%} in the NIPPV group (OR: 3.6; 95{\%} CI: 1.5, 8.7). Days on MVET were 12 ± 11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P = 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39{\%} in the NCPAP group compared to 21{\%} in the NIPPV group (OR: 2.4; 95{\%} CI: 1.02, 5.6). Physiological BPD was 46{\%} in the NCPAP group compared with 11{\%} in the NIPPV group (OR: 6.6, 95{\%} CI: 2.4, 17.8; P = 0.001). There were no differences in any other outcomes between the two groups. Conclusion: NIPPV compared with NCPAP reduced the need for MVET in the first week, duration of MVET, and clinical as well as physiological BPD in preterm infants receiving early surfactant for RDS.",
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T1 - Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks' gestation

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AU - Ramanathan, R.

AU - Sekar, K. C.

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AU - Bhatia, Jatinder J

AU - Soll, R. F.

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N2 - Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants 30 weeks gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery. Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV. Result: A total of 40% of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12 ± 11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P = 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P = 0.001). There were no differences in any other outcomes between the two groups. Conclusion: NIPPV compared with NCPAP reduced the need for MVET in the first week, duration of MVET, and clinical as well as physiological BPD in preterm infants receiving early surfactant for RDS.

AB - Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants 30 weeks gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery. Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV. Result: A total of 40% of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12 ± 11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P = 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P = 0.001). There were no differences in any other outcomes between the two groups. Conclusion: NIPPV compared with NCPAP reduced the need for MVET in the first week, duration of MVET, and clinical as well as physiological BPD in preterm infants receiving early surfactant for RDS.

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