Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: A randomized controlled trial

Abstract BackgroundThe most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications.Methods148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to N-DUOPAP group and 74 neonates to NCPAP group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 hours after birth and secondary outcomes included treatment complications.Resultsthere was not significant difference between DUOPAP (4.1%) and NCPAP (8.1%) in treatment failure at the first 72 hours of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Needing to repeat doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. the duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002).ConclusionIn the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 hours of birth compared to CPAP, but the duration of non-invasive ventilation and of oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group.Trial registration: IRCT20180821040847N1, Approved on 2018-09-10.