title: Is synchronised NIPPV more effective than NIPPV and NCPAP in treating apnoea of prematurity (AOP)? A randomised cross-over trial.
abstract: BACKGROUND
  Apnoea, desaturations and bradycardias are common problems in preterm infants which can be treated with nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV). It is unclear whether synchronised NIPPV (SNIPPV) would be even more effective.
  
  
  OBJECTIVE
  To assess the effects of flow-SNIPPV, NIPPV and NCPAP on the rate of desaturations and bradycardias in preterm infants and, secondarily, to evaluate their influence on pattern of breathing and gas exchange.
  
  
  METHODS
  Nineteen infants (mean gestational age at study 30 weeks, 9 boys) with apnoeic spells were enrolled in a randomised controlled trial with a cross-over design. They received flow-SNIPPV, NIPPV and NCPAP for 4 h each. All modes were provided by a nasal conventional ventilator able to provide synchronisation by a pneumotachograph. The primary outcome was the event rate of desaturations (≤80% arterial oxygen saturation) and bradycardias (≤80 bpm) per hour, obtained from cardiorespiratory recordings. The incidence of central apnoeas (≥10 s) as well as baseline heart rate, FiO2, SpO2, transcutaneous blood gases and respiratory rate were also evaluated.
  
  
  RESULTS
  The median event rate per hour during flow-SNIPPV, NIPPV and NCPAP was 2.9, 6.1 and 5.9, respectively (p<0.001 and 0.009, compared with flow-SNIPPV). Central apnoeas per hour were 2.4, 6.3 and 5.4, respectively (p=0.001, for both compared with flow-SNIPPV), while no differences in any other parameter studied were recorded.
  
  
  CONCLUSIONS
  Flow-SNIPPV seems more effective than NIPPV and NCPAP in reducing the incidence of desaturations, bradycardias and central apnoea episodes in preterm infants.
authors.affiliation: Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Gizzi
authors.affiliation: Medical Engineering Laboratory, Department of Civil Engineering and Computer Science Engineering, "Tor Vergata" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montecchia
authors.affiliation: SeSMIT-A.Fa.R., Medical Statistics & Information Technology, Fatebenefratelli Association for Biomedical and Sanitary Research, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
authors.affiliation: Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Castellano
authors.affiliation: Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mariani
authors.affiliation: Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Maristella
authors.initials: M
authors.lastname: Campelli
authors.affiliation: Pediatric Emergency and Intensive Care, Department of Pediatrics, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Papoff
authors.affiliation: Pediatric Emergency and Intensive Care, Department of Pediatrics, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Agostino
mesh_terms: D001049:Apnea / Q000628:therapy*; D001919:Bradycardia / Q000517:prevention & control; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn
keywords: NCPAP; apnoea; desaturation; preterm infants; synchronized NIPPV