title: Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants.
abstract: BACKGROUND
  Apnoea of prematurity (AOP) is a common problem in preterm infants which can be treated with various modes of nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV). It is not known which mode of NCPAP or NIPPV is most effective for AOP.
  
  
  OBJECTIVE
  To assess the effect of four NCPAP/NIPPV systems on the rate of bradycardias and desaturation events in very low birthweight infants.
  
  
  METHODS
  Sixteen infants (mean gestational age at time of study 31 weeks, 10 males) with AOP were enrolled in a randomised controlled trial with a crossover design. The infants were allocated to receive nasal pressure support using four different modes for 6 h each: NIPPV via a conventional ventilator, NIPPV and NCPAP via a variable flow device, and NCPAP delivered via a constant flow underwater bubble system. The primary outcome was the cumulative event rate of bradycardias (< or =80 beats per minute) and desaturation events (< or =80% arterial oxygen saturation), which was obtained from cardio-respiratory recordings.
  
  
  RESULTS
  The median event rate was 6.7 per hour with the conventional ventilator in NIPPV mode, and 2.8 and 4.4 per hour with the variable flow device in NCPAP and NIPPV mode, respectively (p value<0.03 for both compared to NIPPV/conventional ventilator). There was no significant difference between the NIPPV/conventional ventilator and the underwater bubble system.
  
  
  CONCLUSIONS
  A variable flow NCPAP device may be more effective in treating AOP in preterm infants than a conventional ventilator in NIPPV mode. It remains unclear whether synchronised NIPPV would be even more effective.
authors.affiliation: Department of Neonatology, University Children's Hospital Tuebingen, Tuebingen 72076, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Pantalitschka
authors.forename: J
authors.initials: J
authors.lastname: Sievers
authors.forename: M S
authors.initials: MS
authors.lastname: Urschitz
authors.forename: T
authors.initials: T
authors.lastname: Herberts
authors.forename: C
authors.initials: C
authors.lastname: Reher
authors.forename: C F
authors.initials: CF
authors.lastname: Poets
mesh_terms: D001049:Apnea / Q000628:therapy*; D001724:Birth Weight; D045422:Continuous Positive Airway Pressure; D018592:Cross-Over Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D016896:Treatment Outcome