Critically appraised paper: Nasal continuous positive airway pressure for infants with meconium aspiration syndrome reduces the need for mechanical ventilation in the first seven days of life [synopsis]

Question: Does nasal continuous positive airway pressure reduce the need for mechanical ventilation in the first 7 days of life in neonates with respiratory failure due to meconium aspiration syndrome? Design: Randomised controlled trial with concealed allocation and blinded outcome assessment. Setting: Three tertiary care neonatal intensive care units in India. Participants: Inclusion criteria were infants: born with meconium staining of amniotic fluid; . 35 weeks’ gestation and birth weight . 2000 g; admitted to the neonatal intensive care unit in the first 24 hours of birth due to respiratory distress; and chest radiograph suggestive of meconium aspiration syndrome. Exclusion criteria were: intubation at admission; severe asphyxia (5minute Apgar score , 3 and cord potential of hydrogen level , 7); pneumothorax and/or air leak (visible on the admission chest radiograph); and major malformations. Randomisation of 135 participants allocated 67 to an intervention group and 68 to a control group. Interventions: The intervention group was started on a bubble nasal continuous positive airwaypressuregenerator (Fisher andPaykel Care) using short binasal prongs. The starting pressure was 5 cmH2O. Both the pressure and the fraction of inspired oxygen were adjusted to maintain target oxygen saturation between 90% and 95%. The neonate