A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS.
OBJECTIVE
Comparison of outcomes of infants with respiratory distress syndrome (RDS), post-surfactant, extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV).


METHODS
Prospective post-surfactant randomized controlled trial of primary mode SNIPPV compared with CV in infants (born from July 2000 to March 2005) with birth weights (BW) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS, following the administration of the first dose of surfactant.


RESULTS
There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, BW, gestational age, gender or Apgar at 5 min between infants continued on CV (n=21) and those extubated to primary mode SNIPPV (n=20). Significantly, more babies in the CV group had the primary outcome of bronchopulmonary dysplasia (BPD)/death, compared to the SNIPPV group (52 versus 20%, P=0.03). There was no difference in the incidence of other common neonatal morbidities. There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups.


CONCLUSIONS
Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death. Primary mode SNIPPV is a feasible method of ventilation in small premature infants.
Bhandari
V
V
Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA, USA. vineet.bhandari@yale.edu
Gavino
R G
RG
Nedrelow
J H
JH
Pallela
P
P
Salvador
A
A
Ehrenkranz
R A
RA
Brodsky
N L
NL
D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015300:Ventilator Weaning
D011663:Pulmonary Surfactants