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  • Original Article
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Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

Journal of Perinatology volume 32, pages 336–343 (2012)Cite this article

Subjects

A Corrigendum to this article was published on 27 April 2012

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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Acknowledgements

We acknowledge parents of our study subjects for their trust and participation, nursing and respiratory care practitioners, neonatal fellows and faculty, and the following study coordinators: Rosanna Erickson, NNP (CA), Richard Hernandez, RCP (CA), Mike McCoy, MS, ARNP (OK), Karen Corff, MS, ARNP (OK), Debra McAnn, MS, ARNP (OK), Brooke Burks, MS, ARNP (OK), Michelle Huynh, MS, ARNP (OK), Caitlin Thi, MS, ARNP (OK), Raja Nandyal, MD (OK), Venu Gottipati, MD (OK), Kathy Arnell, RNC (SD) and Delores Gilles, RN, BSN (GA); DSMB members: Dr Vinod Bhutani from Stanford University and Dr Philippe Friedlich from Children's Hospital Los Angeles; Independent Biostatistician Dr Fred Dorey from Children's Hospital Los Angeles (CA). Funding was provided through an unrestricted grant by Dey LP and Chiesi Farmaceutici, SpA. All data analysis and interpretation of the data were independent of the funding agencies. (ClinicalTrials.gov NCT00486850; Funded by Dey LP and Chiesi Farmaceutici, SpA). This study was supported by an unrestricted grant from Dey LP and Chiesi Farmaceutici, SpA.

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Authors and Affiliations

  1. USC Division of Neonatal Medicine, LAC+USC Medical Center, Good Samaritan Hospital and Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA

    R Ramanathan

  2. Neonatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    K C Sekar

  3. Neonatology, Sharp Mary Birch Hospital for Women, San Diego, CA, USA

    M Rasmussen

  4. Neonatology, Georgia Health Sciences University, Augusta, GA, USA

    J Bhatia

  5. Neonatology, The University of Vermont College of Medicine, Burlington, VT, USA

    R F Soll

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Correspondence to R Ramanathan.

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Ramanathan, R., Sekar, K., Rasmussen, M. et al. Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial. J Perinatol 32, 336–343 (2012). https://doi.org/10.1038/jp.2012.1

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