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Initiating nasal continuous positive airway pressure in preterm neonates at 5 cm as against 7 cm did not decrease the need for mechanical ventilation
Author(s) -
Murki Srinivas,
Nathani Prem Prakash,
Sharma Deepak,
Subramaniam Sreeram,
Oleti Tejo Pratap,
Chawla Deepak
Publication year - 2016
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.13385
Subject(s) - medicine , bronchopulmonary dysplasia , continuous positive airway pressure , mechanical ventilation , respiratory distress , anesthesia , ventilation (architecture) , positive pressure , gestational age , pregnancy , mechanical engineering , genetics , engineering , obstructive sleep apnea , biology
Aim The optimum starting nasal continuous positive airway pressure (nCPAP) for infants on bubble nCPAP is unknown. We compared whether an initial bubble nCPAP of 7 cm rather than 5 cm of water prevented the need for mechanical ventilation among preterm neonates with respiratory distress. Methods Preterm neonates born at 27–34 weeks with the onset of respiratory distress within 24 hours of birth were randomised to receive high or standard nCPAP at either 7 cm or 5 cm of water, respectively. The primary outcome was the need for mechanical ventilation in the first week of life. Results The baseline characteristics were comparable between the two groups. The proportion of infants who required mechanical ventilation during the first week of life was similar between the two groups (standard 29/133, 21.8% versus high 30/138, 21.7%), with a relative risk of 0.99 and range of 0.56–1.77. The secondary outcomes were similar between the two groups, including mortality before discharge, pulmonary air leaks, need of surfactant therapy, bronchopulmonary dysplasia and duration of nCPAP. Conclusion Initiating nCPAP at a higher pressure of 7 cm in preterm neonates with respiratory distress, rather than the standard 5 cm, did not decrease the need for mechanical ventilation during the first week of life.