Non-Invasive versus Invasive Ventilatory Support in Neonates

Abstract

T his prospective observational follow up studywasconductedinNICUofGhamraMilitaryHospital to compare CPAP and invasive IPPV ventilation as regards risk factor and complication.One hundredandtwentyneonateswereincluded over a period of one year withthediagnosisofrespiratorydistressnecessitatingventilatorsupport.Studied neonates are compared according to gestational age,birth weight, gender, mode of delivery.Lastly maternal diseases and medications. They also compared according initial mode and duration of ventilation. Results According to our study PROMwasthemostfrequentmaternaldisorderwithinthestudiedneonates,followedbypregnancy-inducedhypertensionandantepartumhemorrhage..ThemostfrequentinitialdiagnosisinthestudiedneonateswasRDS,followedbyTTN,thenpneumonia.InitialIPPVgroupweresignificantlymoreimmatureandsmallerinsizethaninitialCPAPgroup.Theyalsohadsignificantlylower1-and5-minuteAPGARscoresandhigherFio2needsthaninitialCPAPgroup. Therewasstatisticallysignificantlowerplateletcount and higher CRPinIPPVgroupcomparedtoCPAPgroup. NeonateswithinitialIPPVhadsignificantlymorechestx-rayfindings,sepsis,nasalnecrosis,NEC,laryngealedema,andhigherrateofdeath.They weresignificantlymoreacidoticwithhigherco2levels.WithinCPAPbabies,noneofthecomplicationswasaffectedbythegestationalagebeingaboveorbelow30wks.DurationofCPAPaboveoneweekwassignificantlyassociatedwithhigherfailurerate,higherpercentageofcranialUSabnormalitiesandhigherrateofdeath. StatisticallysignificanthigherpercentageofinfantswhofailedCPAPhadchestx-rayfindingsinfantsandcranialUSabnormalitiesandasignificantportionofthemdiedincomparisontothosewhosucceededonCPAP.Highersecretion,NECanddiedinfantsingroupCcomparedtogroupB. TherewasstatisticallysignificantassociationbetweenhigherventilatorsettingsandGA(<30wks),Males,CSandPH(<7.2). Babieswhowereinneedforre-intubationhadlowergestationalageandbodyweight,butthesedifferenceswerenotstatisticallysignificant.Statisticallyhighlysignificantpositivecorrelationbetweeninvasiveventilationdurationandsepsis, NECandlaryngealedema.