Medicina neonatal y pediátrica

Abstracto

Randomized Control Trial: Heated Humidity High Flow Nasal Cannula in Comparison with NCPAP in the Management of RDS in Extreme Low Birth Infants in Immediate Post Extubation Period

Elkhwad M

Background: Respiratory failure in neonates remains a difficult challenge and is associated with high morbidity and mortality. Current practice reflects the belief that limited exposure to invasive mechanical ventilation and careful use of oxygen support, results in less lung injury and improved long term pulmonary outcomes in preterm infants. Respiratory Distress Syndrome (RDS) is a common cause of respiratory failure in preterm infants and occurs in most preterm infants less than 28 weeks gestation. Standard of care involves surfactant administration and providing respiratory support. Objective: To compare the primary outcome, failure of extubation defined by the need for re-intubation and mechanical ventilation within 5 days of initial extubation and secondary outcomes, morbidities and mortality after using of heated humidity high flow nasal cannula (HHHFNC) and Nasal Continuous Positive Airway Pressure (NCPAP) in the immediate post-extubation period for preterm infants between 24 and 28 weeks gestation with respiratory distress syndrome. Methods: 60 preterm infants with gestational ages between 24 and 28 weeks were randomized in this study to either HHHFNC or NCPAP. The primary outcome measured was failed extubation defined by the need for reintubation and mechanical ventilation within 5 days of initial extubation after receiving at least 2 doses of surfactant. Secondary outcome measures included: 1. Duration of respiratory support using HHHFNC/NCPAP. 2. Duration of oxygen requirement. 3. Incidence of complications i.e. Nasal breakdown, Sepsis, Intraventricular hemorrhage, Retinopathy of prematurity and Patent Ductus Arteriosis. Preterm infants who remained intubated for more than 24 hours were excluded from the study. Results: 17.2% of neonates placed on HHHFNC failed extubation and required re-intubation within 5 days of initial extubation compared with 20.8% of neonates placed on NCPAP (p value 1.000). Mean duration of respiratory support using HHHFNC was 37.45 days compared with 40.04 days using NCPAP (p value 0.66). Duration of oxygen requirement for infants placed on HHHFNC was 49.41 days compared with 43.75 days for infants placed on NCPAP (p value 0.58). 25% of infants placed on NCPAP suffered nasal trauma, 12.5% developed sepsis, 12.5% had grades III and IV IVH, 41.67% were reported to have a PDA and 41.67% were reported to have varying stages of ROP. No nasal trauma was reported for infants placed on HHHFNC, 3.5% developed sepsis, 13.79% had grades III and IV IVH, 31.03% were reported to have a PDA and 24.14% were reported to have varying stages of ROP. Conclusion: HHHFNC use is comparable to the use of NCPAP in the immediate post-extubation period for preterm infants between 24 and 28 weeks gestations with Respiratory Distress Syndrome without an increased risk for co-morbid conditions.