Clinical Course of Apnoeic Preterm Infants with Moderate Respiratory Distress Syndrome (RDS) Undergoing Nasal Syncronized Intermittent Mandatory Ventilation (NSIMV) vs Nasal Bi-Level CPAP (SIPAP): A RCT Study

BACKGROUND: Non invasive approaches to neonatal RDS are becoming increasingly popular. Apnoea episodes may influence efficacy of these methods. Little is known about Nasal Syncronized Intermittent Mandatory Ventilation (NSIMV) and Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP) in the acute phase of moderate RDS. OBJECTIVE: To evaluate the need of mechanical ventilation of preterm infants with moderate RDS and apnoea episodes, randomly assigned at 1 hour of life to NSIMV or to Bi-level NCPAP. DESIGN/METHODS: 16 infants (27-32 wks GA), with moderate RDS (a/ApO2 0,2-0,3) assisted from birth with NCPAP (PEEP = 5-6 cmH2O) but presenting > 4 apnoea episodes or > 2 severe apnoea episodes despite of caffeine therapy, were considered eligible and randomly assigned at 1 hour of life to NSIMV (I.T. 0,35 sec, RR 30/min, PEEP 5 cmH2O, PIP 20 cmH2O Group A n=8) (Giulia Neonatal Nasal Ventilator-Ginevri srl Italy) or to Bi-level NCPAP (Time High 1sec, RR 30/min, lower CPAP level 5 cmH2O; higher CPAP level 9 cmH2O, Group B n=8) (Infant Flow SiPAP™ -Viasys Healthcare CA). Intubation took place in case of persistent apnea and/or worsening of RDS despite of INSURE. Need of mechanical ventilation, lenght of respiratory support, oxygen need, occurrence of air leak or gastrointestinal perforation, enteral feeding initiation and length of hospital stay were recorded. RESULTS: Infants had similar characteristics at birth (GA 30.5 ±1,3 v. 30.3±1,8 wks, BW 1251±303 v. 1294±439g, Apgar score at 5' 8,3±1 vs 8,1±0,8, antenatal steroids 7/8 vs 7/8, Gr A vs Gr B). No differences of length of respiratory support, O2 dependency, starting of enteral feeding or lenght of hospital stay. No intubation plus mechanical ventilation was needed. No gastrointestinal perforations, nasal trauma, PNX, BPD or neurological disorders occurred. CONCLUSIONS: Bi-level NCPAP and NSIMV used as respiratory support in neonates with moderate RDS and apnoea episodes were efficacious in preventing mechanical ventilation and showed same short term respiratory outcomes. E-PAS2010808