Nasal Intermittent Positive Pressure Ventilation Versus Nasal Continuous Positive Airway Pressure After Extubation in Neonates With Respiratory Distress Syndrome

Abstract

The present prospective cohort study was done to compare the rate of re-intubation within 7 days after extubation in neonates with RDS and study the complications in premature infants who were randomized in the immediate post-extubation period to either NIPPV or NCPAP. The study included 40 preterm neonates who were admitted to NICU with RDS and required invasive positive pressure ventilation within 1st 48 hours of life. The studied patients were randomly divided into 2 groups: Group I (patients who were extubated to NIPPV ) and group 2 (patients who were extubated to NCPAP) , each group included 20 patient. All patients were subjected to detailed history taking, full clinical examination and investigations including; chest x-ray, complete blood count, CRP and arterial blood gases at the time of enrolment with study. They were 12 (60%) males and 8 (40%) females in both studied groups, their ages ranged between 28 and 35 weeks with mean gestational age of (32.35±2.412) weeks in NIPPV group and (32.45±2.395) weeks in NCPAP group. The present study showed that before extubation, patients in group 2 (NCPAP) had statistical significant higher mean values of PIP and PEEP (16±2 and 4.9±0.3) cm H2O compared to group 1 (NIPPV) (14±2.9 and 4.7±0.5) cm H2O. Moreover, after extubation, group 2 (NCPAP) had a statistical significant higher mean values of oxygenation index (3.6±1.4) than group 1 (NIPPV) (2.6±1). There were non significant statistical differences between both groups in the rate of reintubation. 5 infants (25%) in group 1 (NIPPV) were reintubated; 1 for respiratory failure, 3 for apnea and 1 for increase ventilatory settings. 7 infants (35%) in group 2 (NCPAP) were reintubated; 2 for respiratory failure and 5 for apnea. 4 infants (20%) shows higher risk of reintubation due to atelectasis in group 2 (NCPAP) compared to 2 infants (10%) in group 1 (NIPPV) but without significant difference. 7 infants (35%) shows higher risk of reintubation due to sepsis in group 2 (NCPAP) compared to 4 infants (20%) in group 1 (NIPPV) but without significant difference.