جستجوی مقالات مرتبط با کلیدواژه « NCPAP » در نشریات گروه « پزشکی »

Respiratory distress is the most often encountered problem in preterm infants and the most frequently encountered reason for neonatal intensive care unit (NICU) admission. It can develop into respiratory failure and cause high morbidity and mortality. Noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), was the first line for neonates with respiratory distress. The progression of respiratory distress to respiratory failure in neonates with NCPAP (NCPAP failure) increases the need for mechanical ventilation on the first day of life. With limited resources, clinical observation is critical to predict prognosis and golden time for referral. Downesscores are the accurate and easiest measurement that is used to determine the severity and monitoring of respiratory distress in neonates. However, in Indonesia, there has still been no study that showed an effect of the increment of Downes score in 24 hours and the risk of NCPAP failure.

This study aimed to measure the association of Downes score at birth, ages 2, 6, 12, and 24 hours, and the risk of NCPAP failure in the first 72 hours using survival analysis.

This prospective observational cohort study included all neonates with 28 - 36 weeks gestation born at Hasan Sadikin General Hospital, Bandung, Indonesia, within March to May 2019, with respiratory distress and NCPAP as respiratory support. Clinical monitoring was conducted using Downes score at birth, 2, 6, 12, and 24 hours of age. The time of NCPAP failure in the first 72 hours was also obtained. Survival analysis with Kaplan-Meier and Cox regression was used to determine the association.

This study analyzed 121 neonates at 72 hours with an overall survival rate of 70.2% and a mean survival time of 61.1 hours. Neonates born 28< 32 weeks and birth weight 1000 - 1499 g had the lowest survival (54.5% and 56.9%). Downes score 4 at birth and 2 and 6 hours had lower survival than Downes score < 4 (67.7%, 60.5%, and 52.7%). The risk of NCPAP failure in 72 hourswas increased with a higher Downes score at 2 hours (hazard ratio [HR] = 1.86 [95% confidence interval [CI]: 1.3 - 2.6, P < 0.001), 6 hours (HR = 1.67 [95% CI: 1.2 - 2.2], P < 0.001). Downes score  4 at 2 hours (3.26 times, P = 0.030) and 6 hours (2.44 times, P = 0.014) had a high risk of NCPAP failure in 72 hours.

The increase in Downes score was associated with a high risk of NCPAP failure at 72 hours of age in preterm neonates with respiratory distress. Two to six hours of monitoring of the Downes score should be considered a critical time for referral.

Sleep is a central component of brain development. Preterm neonates follow an exclusive sleep-wake rhythm in a way that they can sleep up to 22 hours per day, 70% of which is spent during active sleep. Sleep can create a period of time for the production of active neurotransmitters, which can enhance brain development flexibility.

It is a matter of controversy whether the widespread use of nonsynchronized nasal intermittent positive pressure ventilation (NIPPV) in neonatal intensive care units and the concerns over the use of nonrespiratory support can affect the quantity and quality of the sleep-wake cycle (SWC). Therefore, the current study aimed to compare two types of intervention, nasal continuous positive airway pressure (nCPAP) and NIPPV, during the SWC.

The present randomized controlled trial crossover study was conducted on neonates with 28 - 32 weeks of gestation receiving nCPAP who had been administered surfactant after being diagnosed with respiratory distress syndrome in Shahid Beheshti hospital in Isfahan, Iran, within March 2018 to August 2020. The SWC was monitored using cerebral function monitoring for all study participants.

The present study showed no significant difference between the number of SWCs during nCPAP and NIPPV. The duration of SWCs when participants received nCPAP was significantly higher than when they received NIPPV intervention. Rapid eye movement (REM) sleep duration was significantly longer during nCPAP respiratory support. Furthermore, NonREM sleep duration was significantly longer in nCPAP respiratory support.

Noninvasive respiratory support modes can affect the SWC, with nCPAP being the favored in the present study. Nonetheless, further studies are required to be performed in this regard.

There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).

The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth.

The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth  compared to the control group (8.3% vs. 27.7%, P=0.014); however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56.2%, P=0.332), the mean respiratory support duration (6.89±3.20 vs. 6.70±3.71 days, P=0.295), the mean hospital stay (19.52±12.364 vs. 17.40±9.57 days, P=0.591), development of bronchopulmonary dysplasia (4.2% vs. 8.5%, P=0.435), and mortality (6.25% vs. 12.8%, P=0.317).

Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LISA

Respiratory distress syndrome (RDS) is considered one of the most common causes of morbidity in neonates. None of the interventions made in the last three decades to manage this disease has been able to affect the development of RDS as much as surfactant replacement.

Although the standard approach is intubation during surfactant administration, the development of alternative methods in surfactant administration, such as surfactant administration using nebulizers, has been considered that is the aim of the current study.

This randomized controlled trial was conducted on neonates with a gestational age of 28 - 32 weeks with RDS under nasal continuous positive airway pressure (nCPAP) in Beheshti Medical Center in Isfahan, Iran, within March 2018 to August 2020. The neonates requiring the fraction of inspired oxygen ≥ 0.4 for periods longer than 30 minutes to maintain oxygen saturation in the right hand within the range of 89 - 95% while being supported under continuous distending pressure ≥ 5 cm H2O were randomly divided into a control group and an intervention group. Survanta was administered in the control group through INSURE method and aerosolization using mesh nebulizers in the intervention group.

This study showed no significant difference in the arterial/alveolar oxygen ratio gradient after Survanta administration (P-value: 0.10), need for subsequent doses of surfactant (P-value: 0.771) and mechanical ventilation (P-value: 0.145), prevalence of pneumothorax (P-value: 0.50), chronic lung disease (P-value: 0.269), and high-grade intraventricular hemorrhage (P-value: 0.221), duration of nCPAP support (P-value: 0.089), or prevalence of death between the two groups (P-value: 1.00).

Since aerosolization is considered to be a noninvasive method, it is required to perform further studies to improve this approach.

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. 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. 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. 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). 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.

Respiratory distress syndrome (RDS) is a common lung problem in neonates born before 28 weeks of pregnancy. The current study aimed to assess the clinical outcomes of Nasal Continuous Positive Airway Pressure (NCPAP), as compared to humidified high flow nasal cannula (HHFNC) in the treatment of premature neonates with RDS.

This randomized control trial was conducted on 60 preterm neonates (gestation

There were no significant differences in primary and secondary outcomes, including pneumothorax, patent ductus arteriosus (PDA), chronic lung disease, surfactant injection, tracheal intubation, death, necrotizing enterocolitis (NEC), days of delay in establishing full enteral feeds, duration of hospitalization, and the number of the days for oxygen requirement between NCPAP and HHFNC groups.

HHFNC and NCPAP techniques have the same efficacy in the treatment of RDS in neonates, and there was no difference between the two techniques in terms of treatment failure and clinical outcomes. Since HHFNC is less invasive with the same efficacy compared to CPAP, we recommend that it can be used as a primary modality in preterm neonates with RDS.

Infant respiratory distress syndrome (IRDS) is one of the main causes of serious complications and death in preterm infants. Both Nasal Continuous Positive Airway Pressure (NCPAP) and Nasal Intermittent Positive Pressure Ventilation (NIPPV) are known as the most common treatment strategies for IRDS. The present study intended to compare NCPAP and NIPPV in the treatment of preterm infants with respiratory distress syndrome.
To this double blind clinical trial study during a one-year period (2016 to 2017) in Fatemieh Hospital in Hamadan city (Iran), about 60 preterm RDS infants were randomly assigned into two treatment groups; the NIPPV group received the PIP (14–20 cmH2O), RR: 30-50/min, PEEP (5–6 cmH2O), FiO2 up to 60%. The NCPAP group received PEEP (5-6 cmH2o), Flow: 6-7 L/min, and FiO2 up to 60%
There was not any significant difference in the mean values of gestational age (30.07±1.50 vs. 30.07±2.05; P>0.05), birth weight (1259±263 vs. 1235±285; P>0.05), and 1-minute Apgar score (5.53±1.13 vs. 5.33±1.34; P>0.05) between NIPPV and NCPAP treatment groups. Besides, the rate of recovery, mortality and disease complications was not significantly different between both groups. However, the duration of respiratory support was less in NIPPV than NCPAP (34.9±33.8 vs. 68.4±32 h; P=0.001).
According to the results, there was not significant advantage between the NIPPV vs. NCPAP methods in the treatment of RDS in preterm infants with very low birth weight.

Non-invasive ventilation (NIV) has brought about significant changes in care and treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. The present study was designed and conducted to evaluate different strategies of initial respiratory support (IRS) in VLBW neonates, who were hospitalized in the neonatal intensive care unit (NICU).
This prospective study was conducted from 21st of March, 2015 to 20th of March, 2016 at the NICU division of Mahdieh Maternity hospital. Each eligible VLBW infant with diagnosis of RDS, received a specific IRS, including nasal continuous positive airway pressure (NCPAP) or nasal intermittent mandatory ventilation (NIMV). All infants with mild to moderate RDS, weighing less than 1500 g, were enrolled in NCPAP and NIMV groups in a randomized manner and their clinical course were evaluated by the neonatologists or the neonatology fellows. The information of medical files was recorded in a data form designed to include all prenatal and post-natal information in accordance with the objectives of the study. The obtained data were then statistically analyzed.
Of 76 infants, who met the criteria to enter the study, 28 cases (36.8%) were males and 48 cases (63.2%) were females. Twenty-two infants (28.9%) were included in the NCPAP group and 54 infants (71.1%) in the NIMV group. The mean gestational age was 29.2 weeks. The mean birth weight was 1148 g (birth weight range between 550 and 1500 g). Intubation was performed in 8 of 22 infants (36.4%) in the NCPAP group and 32 of 54 (59.3%) newborns in the NIMV group. Surfactant was administered in 4 of 22 (18.2%) newborns in the NCPAP group and 31 of 54 (57.4%) newborns in the NIMV group. Pneumothorax did not occur in the 22 infants, who were under NCPAP, yet did occur in 4 of 54 (7.4%) infants in the NIMV group. Intra ventricular hemorrhage was reported in 2 of 22 (9.1%) newborns in the NCPAP group and 6 of 54 (13%) newborns in the NIMV group. Furthermore, BPD was reported in none of the 22 infants, who were under NCPAP, while it occurred in 2 newborns (3.7%) in the NIMV group.
Although NIMV improves minute ventilation and tidal volume through increasing the air flow and theoretically improves respiratory condition by reducing dead space, its effectiveness as the first step respiratory support in very premature infants is under question. The other problem with NIMV is the necessity of ventilator usage and its higher expenses in comparison to NCPAP. It seems that as the first step of respiratory support; NCPAP is still the preferred method in very premature infants.

Respiratory distress syndrome (RDS) is one of the most common diseases in neonates admitted to NICU. For this important cause of morbidity and mortality in preterm neonates, several treatment methods have been used. To date, non-invasive methods are preferred due to fewer complications.
Herein, two non-invasive methods of ventilation support are compared: NCPAP vs. NIPPV.
Patients and This is a randomized clinical trial. Premature neonates with less than 34 weeks gestation, suffering from RDS entered the study, including 151 newborns admitted to Vali-Asr NICU during 2012-2013. Most of these patients received surfactant as early rescue via INSURE method and then randomly divided into two NCPAP (73 neonates) and NIPPV (78 neonates) groups. Both early and late complications are compared including extubation failure, hospital length of stay, GI perforation, apnea, intraventricular hemorrhage (IVH) and mortality rate.
The need for re-intubation was 6% in NIPPV vs. 17.6% in NCPAP group, which was statistically significant (P = 0.031). The length of hospital stay was 23.92 ± 13.5 vs. 32.61 ± 21.07 days in NIPPV and NCPAP groups, respectively (P = 0.002). Chronic lung disease (CLD) was reported to be 4% in NCPAP and 0% in NIPPV groups (P = 0.035). The most common complication occurred in both groups was traumatization of nasal skin and mucosa, all of which fully recovered. Gastrointestinal perforation was not reported in either group.
This study reveals the hospital length of stay, re-intubation and BPD rates are significantly declined in neonates receiving NIPPV as the treatment for RDS.

Surfactant administration together with nasal Continuous Positive Airway Pressure (nCPAP) administration is considered to be the basis for Newborn’s Respiratory Distress Syndrome (RDS) management. This study evaluated the method of directing the surfactant to the lungs in newborns affiliated with RDS through i-gel (i-gel surfactant administration/i-gelSA) compared to the standard care INSURE method, in a clinical trial.

This randomized control trial (RCT) was done on newborns weighing ≥2000 g, with RDS, while being supported with Bubble-CPAP. Newborns, which required FiO2 ≥0.3 under Continuous Distending Pressure (CDP) ≥5 cm H2 O for more than 30 minutes to maintain SpO2 in the range of 89 - 95%, were given 100 mg/kg of Survanta. In the interventional group or the i-gelSA (i-gel Surfactant Administration) group, 35 newborns experienced surfactant administration with i-gel and 35 newborns in the control or INSURE group. The average a/APO2 before and after surfactant administration, repeated need for surfactant administration, average nCPAP duration, need for invasive mechanical ventilation, pneumothorax, and the average duration of hospitalization in the Neonatal Intensive Care Unit (NICU) were compared.

Although the average a/APO2 showed no significant difference before the procedure; in the i-gelSA group, this average was meaningfully higher after the administration of the surfactant (P = 0.001). The other factors showed no significant difference.

According to the results of this study, the surfactant administration using i-gel was more successful in oxygenation improvement than the INSURE method, and the i-gel method could even be promoted to the standard care position. However, more research is needed in this area.

Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS.