Abstract
NASAL/BUBBLE CPAP VERSUS MECHANICAL VENTILATION FOR RESPIRATORY SUPPORT IN PRETERM INFANTS AT BIRTH

Fatima Mohsen, Sirin Mneimneh*, Amal Naous and Mariam Rajab

ABSTRACT

Background: Preterm neonates are at risk of respiratory distress syndrome (RDS) and require mechanical ventilation to keep them alive. However, there are complications associated with mechanical ventilation which are mostly iatrogenic. Of these, Ventilator-Induced Lung Injury (VILI) has long been recognized as a contributor to the development of bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD). There has been increased interest in continuous positive airway pressure (CPAP) as a primary ‘gentler’ mode of respiratory support in RDS to improve mortality and reduce the occurrence of long-term respiratory morbidity. Methods: We performed a retrospective study, involving neonates who were born between 24 weeks 0 days and 36 weeks 6 days of gestation. Neonates were managed by CPAP or mechanical ventilation strategy. The primary outcomes were death, bronchopulmonary dysplasia (BPD), and duration of hospital stay. The secondary outcomes were patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and pneumothorax. Results: A total of 250 neonates were enrolled in the study. The rates of the primary outcomes (death, BPD, and duration of hospital stay) and part of the secondary outcomes (PDA and NEC) were statistically significant between the two strategies (CPAP and mechanical ventilation). Pneumothorax didn't show any statistically significance difference between the two groups. Neonates who were managed by CPAP strategy, showed lower incidence of BPD (P-value= 0.046), PDA (P-value=0.016), NEC (P-value=0.001), and death (P-value <0.0001), and shorter duration of hospital stay (P-value<0.0001). Conclusion: The result of this study supports consideration of CPAP as an alternative strategy to intubation and mechanical ventilation in preterm neonates for respiratory support at birth.

Keywords: Preterm neonates; CPAP; Mechanical ventilation.


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