Nasal DUOPAP vs nasal continuous positive airway pressure in preterm neonates with respiratory distress syndrome - A randomized control trial.

BACKGROUND

There has been major shift in choice of respiratory support in preterm babies from invasive to non-invasive. There are various modes of non-invasive respiratory support. The comparative efficacy of one mode over another is an important research area.

OBJECTIVE

To evaluate effectiveness of Nasal duo positive airway pressure (NDUOPAP) vs nasal continuous positive airway pressure (NCPAP) in reducing need of mechanical ventilation in preterms ≤35 weeks of gestation with respiratory distress syndrome.

DESIGN

Open label, non-inferiority Randomized controlled trial.

SUBJECTS: 122 Neonates with GA ≤ 35 weeks (61 in NDUOPAP and 61 in NCPAP) with RDS & Silverman Andersen score ≥ 4, admitted to NICU.

PRIMARY OUTCOME: Failure of allocated modes within first 120 h after birth.

RESULTS

There was no significant difference between NDUOPAP: 11(18 %) and NCPAP:12(19.7 %) in treatment failure at the first 120 h of birth (p = 0.817). The morbidities including Patent Ductus Arteriosus, Pneumothorax, Intraventricular Hemorrhage, Sepsis, Necrotizing Enterocoilitis, Apnea of prematurity, Bronchopulmonary Dysplasia, Retinopathy of prematurity & mortality were similar between the two groups. The duration of non-invasive respiratory support, mechanical ventilation, oxygen therapy were also not significantly different. However the need for surfactant was lower in the NDUOPAP group when compared to NCPAP (p = 0.018).

CONCLUSIONS

NDUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 120 h of birth in preterms with RDS.