Comparison of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Mandatory Ventilation in Early Respiratory Support of Very Low Birth Weight Infants with Respiratory Distress Syndrome

Non-invasive ventilation (NIV) has brought about significant changes in care and treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. The present study was designed and conducted to evaluate different strategies of initial respiratory support (IRS) in VLBW neonates, who were hospitalized in the neonatal intensive care unit (NICU).
This prospective study was conducted from 21st of March, 2015 to 20th of March, 2016 at the NICU division of Mahdieh Maternity hospital. Each eligible VLBW infant with diagnosis of RDS, received a specific IRS, including nasal continuous positive airway pressure (NCPAP) or nasal intermittent mandatory ventilation (NIMV). All infants with mild to moderate RDS, weighing less than 1500 g, were enrolled in NCPAP and NIMV groups in a randomized manner and their clinical course were evaluated by the neonatologists or the neonatology fellows. The information of medical files was recorded in a data form designed to include all prenatal and post-natal information in accordance with the objectives of the study. The obtained data were then statistically analyzed.
Of 76 infants, who met the criteria to enter the study, 28 cases (36.8%) were males and 48 cases (63.2%) were females. Twenty-two infants (28.9%) were included in the NCPAP group and 54 infants (71.1%) in the NIMV group. The mean gestational age was 29.2 weeks. The mean birth weight was 1148 g (birth weight range between 550 and 1500 g). Intubation was performed in 8 of 22 infants (36.4%) in the NCPAP group and 32 of 54 (59.3%) newborns in the NIMV group. Surfactant was administered in 4 of 22 (18.2%) newborns in the NCPAP group and 31 of 54 (57.4%) newborns in the NIMV group. Pneumothorax did not occur in the 22 infants, who were under NCPAP, yet did occur in 4 of 54 (7.4%) infants in the NIMV group. Intra ventricular hemorrhage was reported in 2 of 22 (9.1%) newborns in the NCPAP group and 6 of 54 (13%) newborns in the NIMV group. Furthermore, BPD was reported in none of the 22 infants, who were under NCPAP, while it occurred in 2 newborns (3.7%) in the NIMV group.
Although NIMV improves minute ventilation and tidal volume through increasing the air flow and theoretically improves respiratory condition by reducing dead space, its effectiveness as the first step respiratory support in very premature infants is under question. The other problem with NIMV is the necessity of ventilator usage and its higher expenses in comparison to NCPAP. It seems that as the first step of respiratory support; NCPAP is still the preferred method in very premature infants.