A comparative study of the use of continuous positive airway pressure with or without surfactant in management of preterm with respiratory distress

الملخص EN

Background: Respiratory Distress Syndrome (RDS) is a clinical manifestation due to a deficiency or dysfunction of pulmonary surfactant.

The use of continuous positive airway pressure (CPAP) for RDS produces a more regular breathing pattern, establishes and maintains functional residual capacity, decreases upper airway resistance, results in progressive alveolar recruitment, inflates collapsed alveoli and reduces intrapulmonary shunting, promotes the release of and conservation of surfactant on the alveolar surface.

Objectives: The aim of the study was comparing nasal continuous positive airway pressure (NCPAP) with and without surfactant therapy in the management of preterm neonates with RDS.

Patients and methods: This is a randomized, controlled clinical trial that performed on 100 newborns (28-32 weeks) who were born in Assiut University Hospital (Egypt) from T' of January 2011 to the end of December 2011 with evidence of mild to moderate respiratory distress syndrome.

They were treated with supplemental oxygen in the delivery room and randomly assigned within the 48 hours of life to intubation, early surfactant, exlubation, and nasal continuous positive airway pressure (treatment group) or nasal continuous airway pressure only (control group).

Results: within one year 100 infants were randomly assigned, 50 to the treatment group and 50 to the control group.

The need for mechanical ventilation, intraventricular hemorrhage and mortality were significantly lower in the treatment group; however PDA was higher in the treatment group.

All other outcomes were comparable between both groups.

Conclusion: NCPAP is a safe protocol for RDS in preterm neonates and it decreased the need for subsequent mechanical ventilation and decreased the incidence of air-leak syndrome especially when combined with early surfactant therapy.

Reduction in the need for mechanical ventilation is an important achievement when medical Resources are limited and may result in less chronic lung disease in both developed and developing countries