Comparing the Efficacy of NCPAP and NIPPV in Infants with RDS after Extubation; A Randomized Clinical Trial

Background: Respiratory distress syndrome (RDS) is the most common respiratory disorder of premature infants and leading cause of mortality. The main progress in RDS management is attributable to prescription of surfactant for fastening pulmonary maturation. Objectives: In this study we aimed to compare nasal continuous positive airway pressure (NCPAP) with nasal intermittent positive pressure ventilation (NIPPV) in infants with RDS lower than 1800 gr of birthweight. Methods: In this randomized clinical trial, infants with confirmed diagnosis of RDS who underwent treatment with surfactant and mechanical ventilation were randomly allocated to two NCPAP and NIPPV groups. Duration of hospitalization, oxygen therapy, respiratory protection, need for re-intubation and complications were recorded in a pre-designed checklist. Results: Eventually 60 (37 males and 23 females) infants with mean gestational ages of 31.73±1.72 weeks in NCPAP and 32.6±1.92 weeks in NIPPV group underwent analysis (p=0.096). Infants in NCPAP group underwent mechanical ventilation for a mean duration of 3.3±1.7 days; while it was 2.4±0.96 days for infants in NIPPV group (p=0.026). The mean received doses of surfactant was 2.36±0.66 in NCPAP and 1.9±0.25 in NIPPV group (p=0.005). After intervention, infants in NCPAP group had a mean arterial oxygen saturation of 91.36±3.03%; while it was 91.3±4.03% for those in NIPPV group (p=0.669). Mean arterial oxygen pressure was 67.6±6.91 mmHg in NCPAP group and 75.2±7.2 mmHg in NIPPV group after intervention (p=0.045). Conclusion: We found that NIPPV is more effective than NCPAP in decreasing need for reintubation and invasive mechanical ventilation in premature infants with respiratory distress syndrome and it also shortens the duration of hospitalization.