title: Nasal continuous positive airway pressure versus nasal intermittent positive-pressure ventilation within the minimally invasive surfactant therapy approach in preterm infants: a randomised controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive-pressure ventilation (NIPPV) as the initial respiratory support within the minimally invasive surfactant therapy (MIST) approach in preterm infants with respiratory distress syndrome.
  
  
  METHODS
  Prospective, randomised controlled study.
  
  
  METHODS
  Tertiary neonatal intensive care unit.
  
  
  METHODS
  This study enrolled 200 preterm infants with a gestational age of 26-32 weeks who showed signs of respiratory distress but did not require intubation in the delivery room. Surfactant therapy was performed using the MIST approach in the patients who met the criteria for surfactant administration.
  
  
  METHODS
  The primary outcomes were a need for intubation within the first 72 h of life and a surfactant requirement.
  
  
  RESULTS
  The infants in the study displayed similar characteristics at birth. Fewer infants in the NIPPV group required surfactant therapy (38% vs 60%; p=0.002) or invasive ventilation during the first 72 h of life (13% vs 29%; p=0.005), and NIPPV reduced the rate of moderate-to-severe bronchopulmonary dysplasia (BPD) (7% vs 16%; p=0.046). Multivariate logistic regression analysis showed that NIPPV support (OR: 0.36, 95% CI 0.17 to 0.76; p=0.008) and higher gestational age (OR: 0.76, 95% CI 0.59 to 0.98; p=0.041) reduced the need for invasive ventilation within the first 72 h of life. Surfactant requirement was also decreased with NIPPV support (OR: 0.39, 95% CI 0.22 to 0.71; p=0.002). However, there was no impact on BPD, based on the multivariate analysis.
  
  
  CONCLUSIONS
  In infants born at 26-32 weeks' gestation, NIPPV reduced the need for invasive ventilation and the surfactant requirement within the MIST approach.
  
  
  BACKGROUND
  ClinicalTrials.gov under identifier NCT01741129.
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Mehmet Yekta
authors.identifier: http://orcid.org/0000-0003-0760-0773
authors.initials: MY
authors.lastname: Oncel
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Arayici
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Nurdan
authors.initials: N
authors.lastname: Uras
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Evrim
authors.initials: E
authors.lastname: Alyamac-Dizdar
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Sari
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Karahan
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Fuat Emre
authors.initials: FE
authors.lastname: Canpolat
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors.forename: Serife Suna
authors.initials: SS
authors.lastname: Oguz
authors.affiliation: Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey Department of Pediatrics, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Dilmen
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants
keywords: Nasal continuous positive airway pressure; noninvasive ventilation; minimally; bronchopulmonary dysplasia; minimally invasive surfactant therapy; nasal intermittent positive-pressure ventilation; preterm