Compare the Effects of Continuous Positive Airway Pressure with Two Different Methods to Treat Premature Infants with Respiratory Distress Syndrome

Various continuous positive airway pressure (CPAP) devices have been used in treatment of neonates with respiratory distress syndrome (RDS). This study was designed to compare the efficacy of bubble CPAP versus medijet CPAP, used along with surfactant, to treat RDS during the first hours of life. Eighty-eight neonates with gestational age between 29 to 336/7 weeks who had clinical manifestations of RDS and required FIO2 > 21% were randomly assigned to receive either bubble CPAP or medijet CPAP (44 in each group). During the first 30 to 60 minutes of life, if CPAP rises to 8 cm H2O and FIO2 requirement exceeds 40%, surfactant was administered via endotracheal tube. The procedure was repeated twice more at 12 hour intervals, if CPAP treatment had to be continued with FIO2 > 30%. Mechanical ventilation was considered in the presence of clinical or laboratory evidence of respiratory failure. Duration of CPAP treatment and oxygen therapy, need for second and third doses of surfactant and mechanical ventilation, and the occurrence of chronic lung disease (CLD) and pneumothorax were compared between groups. There was no significant difference in the duration of CPAP treatment and oxygen therapy between bubble CPAP and medijet CPAP groups (47 ± 25.7 vs. 46.7 ± 22.4 [P = 0.874] and 158.7 ± 191.9 vs. 144 ± 165.9 [P = 0.702], respectively). The need for second and third doses of surfactant and mechanical ventilation, and the occurrence of CLD and pneumothorax were not significantly different between groups (P was 1, 0.361, 1, 0.72 and 1, respectively). Considering the limited available data, it is highly recommended to evaluate the similar efficacy of bubble CPAP and medijet CPAP in treatment of RDS, along with the use of surfactant, in other large clinical trials.