Original article
Nasal Intermittent Mandatory Ventilation Versus Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome: A Randomized, Controlled, Prospective Study

https://doi.org/10.1016/j.jpeds.2007.01.032Get rights and content

Objective

To evaluate whether nasal intermittent mandatory ventilation (NIMV) compared with nasal continuous positive airway pressure (NCPAP) would decrease the requirement for endotracheal ventilation in the treatment of respiratory distress syndrome (RDS) in preterm infants <35 weeks.

Study design

Randomized, controlled, prospective, single-center study. Forty-one infants were randomized to NCPAP and 43 comparable infants to NIMV (birth weight 1533 ± 603 vs 1616 ± 494 g, gestational age 30.6 ± 3.0 vs 31.1 ± 2.3 weeks, P = .5, respectively).

Results

Infants treated with NIMV and with NCPAP had comparable cardio-respiratory status at study entry. In the total cohort, infants treated initially with NIMV needed less endotracheal ventilation than infants treated with NCPAP (25% vs 49%, P < .05) with a similar trend in infants <1500 g; 31% vs 62%, P =. 06). When controlling for weight and gestational age, NIMV was more successful in preventing endotracheal ventilation (P < .05). Infants treated with NIMV had a decreased incidence of bronchopulmonary dysplasia (BPD) compared with those treated with NCPAP (2% vs 17%, P <. 05, in the total cohort and 5% vs 33%, P <. 05, for infants <1500 g).

Conclusions

NIMV compared with NCPAP decreased the requirement for endotracheal ventilation in premature infants with RDS. This was associated with a decreased incidence of BPD.

Section snippets

Procedure

This was a prospective, open, controlled, single-center, clinical trial comparing the effectiveness of NCPAP and NIMV in the treatment of RDS. RDS was defined in the presence of clinical features and a positive chest x-ray film. The study was approved by the institutional review board in our center. All the parents signed informed consent before participating in the study. Endotracheal intubation was performed in the delivery room if the heart rate did not increase to >100 beats/min, or if the

Results

Of 232 infants born <35 weeks during the study period, 10 infants were excluded (1 infant because of hydrops fetalis, 1 infant because of esophageal atresia and tracheoesophageal fistula, 1 infant because of unstable clinical condition caused by sepsis and disseminated intravascular coagulation, 3 infants because of no available respirator with synchronized NIMV, 2 infants because of lack of parental consent, and 2 infants who started on nasal support without prior randomization). Of the

Discussion

We found that NIMV was more successful than NCPAP as the initial treatment of RDS in premature infants (<35 weeks) by reducing the rate of endotracheal ventilation. This was associated with a reduced incidence of BPD.

To our knowledge, there are no previous published studies that assessed whether NIMV or NCPAP is preferred in the initial treatment of RDS. However, a few studies have found that NIMV was superior to NCPAP post extubation, after mechanical ventilation and surfactant treatment, for

References (24)

  • H. Verder et al.

    Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation

    Pediatrics

    (1999)
  • P.G. Davis et al.

    Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants

    The Cochrane Data Sys Rev

    (2003)
  • Cited by (0)

    View full text