title: Noninvasive ventilation strategies for early treatment of RDS in preterm infants: an RCT.
abstract: OBJECTIVE
  There is evidence that new methods of noninvasive ventilation (NIV) support have significantly changed respiratory distress syndrome (RDS) management in preterm infants. Further perspectives for neonatologists involve the assessment of different NIV strategies in terms of availability, effectiveness, and failure. This study evaluates the efficacy of 2 different NIV strategies for RDS treatment in very low birth weight (VLBW) infants: nasal synchronized intermittent positive pressure ventilation (NSIPPV), which is a modality of conventional ventilation with intermittent peak inspiratory pressure, and bilevel continuous positive airway pressure (BiPAP), not synchronized, with 2 alternate levels of continuous positive airway pressure.
  
  
  METHODS
  We conducted a 2-center randomized control study in 124 VLBW infants (<1500 g and <32 weeks of gestational age) with RDS who received NIV support (NSIPPV, n = 62; BiPAP, n = 62) within 2 hours of birth. We evaluated the performance of NIV strategies by selected primary outcomes (failure rate and duration of ventilation) and secondary outcomes.
  
  
  RESULTS
  The number of failures and duration of ventilation support did not differ between NSIPPV and BiPAP strategies (P > .05 for both). Moreover, no differences between groups were found regarding secondary outcomes (P > .05 for all).
  
  
  CONCLUSIONS
  The present data show no statistically significant differences between NSIPPV and BiPAP strategies in terms of duration of ventilation and failures, suggesting that both NIV techniques are effective in the early treatment of RDS in VLBW infants. Further randomized investigations on wider populations are needed to evaluate the effect of NIV techniques on long-term outcomes.
authors: Neonatal ICU, "G. Martino" University Hospital of Messina, Italy;
authors: Vincenzo
authors: V
authors: Salvo
authors: Neonatal ICU, V. Buzzi Children's Hospital, Milan, Italy;
authors: Gianluca
authors: G
authors: Lista
authors: Neonatal ICU, V. Buzzi Children's Hospital, Milan, Italy;
authors: Enrica
authors: E
authors: Lupo
authors: Neonatal ICU, C. Arrigo Children's Hospital, Alessandria, Italy;
authors: Alberto
authors: A
authors: Ricotti
authors: Department of Pediatrics and Neonatology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands; and.
authors: Luc J I
authors: LJ
authors: Zimmermann
authors: Department of Pediatrics and Neonatology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands; and Institute of Biomedicine, Catholic University of Guayaquil, Ecuador.
authors: Antonio W D
authors: AW
authors: Gavilanes
authors: Neonatal ICU, "G. Martino" University Hospital of Messina, Italy;
authors: Ignazio
authors: I
authors: Barberi
authors: Neonatal ICU, C. Arrigo Children's Hospital, Alessandria, Italy;
authors: Micaela
authors: M
authors: Colivicchi
authors: Neonatal ICU, C. Arrigo Children's Hospital, Alessandria, Italy;
authors: Francesca
authors: F
authors: Temporini
authors: Neonatal ICU, C. Arrigo Children's Hospital, Alessandria, Italy; dgazzolo@hotmail.com.
authors: Diego
authors: D
authors: Gazzolo
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D008297:Male; D063087:Noninvasive Ventilation / Q000592:standards*; D017410:Practice Guidelines as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: bilevel CPAP; nasal synchronized intermittent positive pressure ventilation; noninvasive ventilation; respiratory distress syndrome; very low birth weight