A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS

Objective: Comparison of outcomes of infants with respiratory distress syndrome (RDS), post-surfactant, extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV). Study Design: Prospective post-surfactant randomized controlled trial of primary mode SNIPPV compared with CV in infants ( born from July 2000 to March 2005) with birth weights ( BW) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS, following the administration of the first dose of surfactant. Result: There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, BW, gestational age, gender or Apgar at 5 min between infants continued on CV (n = 21) and those extubated to primary mode SNIPPV ( n 20). Significantly, more babies in the CV group had the primary outcome of bronchopulmonary dysplasia ( BPD)/death, compared to the SNIPPV group ( 52 versus 20%, P = 0.03). There was no difference in the incidence of other common neonatal morbidities. There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups. Conclusion: Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death. Primary mode SNIPPV is a feasible method of ventilation in small premature infants.