A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants.

Aim: Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation have both been proposed as a form of gentle respiratory support for neonatal respiratory distress syndrome. We have compared these two respiratory support methods in the management of early stages of mild-moderate, neonatal respiratory distress syndrome.

Methods: A prospective, randomized trial was performed enrolling 88 consecutive preterm infants with mild to moderate respiratory distress syndrome matched for birthweight, gestational age, sex, admission FiO2 and Apgar scores. Nasal continuous positive airway pressure was delivered at a pressure of 4-6 cmH2O. Infants on intermittent pressure were put on ventilatory rates of 40 breaths per minute. Peak pressures of 14-20 cmH2O and end-expiratory pressures of 4-6 cmH2O were used judging clinically the chest cage expansion.

Results: Although there were no differences in the PaO2 values between the groups, infants treated with nasal intermittent positive pressure ventilation showed a significantly lower pCO2 values than those in the continuous pressure group (40+/-2 vs 58+/-4 mmHg, P<0.05). Also a significantly lower incidence of apnoeic episodes (number of episodes/hour 0.4+/-0.2 vs 0.9+/-03; P<0.05) and a shorter respiratory support in the nasal intermittent positive pressure ventilation group were observed. No difference in severe abdominal distension or need of endotracheal intubation was noted.

Conclusions: In the present clinical setting, the use of nasal positive airway pressure in an intermittent way is associated to a more physiological arterial carbon dioxide tension, less apnoea and a shorter duration of respiratory support when compared with continuous pressure delivery by the same route.