Mortality rate among Preterm Infants with Respiratory Distress Syndrome on Non-Invasive Respiratory Support (NIRS): A ٌRetrospective multicenter study

Article Type

Original Study

Subject Area

Pediatrics

Abstract

Background: Neonatal acute respiratory distress is a common cause for mortality and morbidity in preterm neonates. Non-invasive ventilation is crucial for preterm neonates, nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure. Recently, heated humidified high-flow nasal cannula modes have been revealed as more efficient non-invasive ventilation mode in improving functional residual capacity however, other studies have questioned its efficacy and safety in comparison to other non-invasive ventilation. Many studies have investigated the common predictive factors that are associated with intubation and failure of spontaneous breathing. Consequently, this study aimed at investigating the common factors associated with prolonged hospital stay and death in preterm neonates. Methodology: a prospective multi-center, three-arms, parallel, randomized trial was conducted between four Egyptian NICUs on preterm neonates with respiratory distress syndrome delivered and entered to neonatal intensive care unit using either nasal intermittent positive pressure ventilation, nasal continuous positive airway pressure or heated humidified high-flow nasal cannula modes at Mataria Teaching Hospital, Misr Qadema Mabarra Hospital, Maadi Mabarra Hospital and Gameya Shareya Hospital in 6th of October city. A total of 120 neonates from NICUs were included in this study. Informed consents were obtained from parents of each neonate participating with full details about the study procedure and the benefits. Results: Our study has detected lower hospital stay with nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure followed by heated humidified high-flow nasal cannula modes. In fact, heated humidified high-flow nasal cannula modes median survival time was 318 hours which is shorter than the median survival time in case of nasal continuous positive airway pressure mode (360 hours). Moreover, adjusted odds of intubation increased by 12% in heated humidified high-flow nasal cannula modes and decreased by 54% in nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in comparison with nasal continuous positive airway pressure. In gestational age, each weak increased following 34 weeks, decreases the hazard of intubation by 22%. Furthermore, factors as apnea, pulmonary hemorrhage, nasal bleeding and pressure necrosis as well as hypoventilation were predictors for intubation failure. Conclusion: Despite the known benefits of heated humidified high-flow nasal cannula mode, nasal intermittent positive pressure ventilation was superior in preventing intubation in comparison with both heated humidified high-flow nasal cannula modes and nasal continuous positive airway pressure. Future large-scale studies are recommended to assess each predictive factor increasing the risk for intubation or even death.

IRB Number

HM00153

Keywords

Preterm Infants, Respiratory Distress Syndrome, Non-Invasive Respiratory Support

Recommended Citation

Hamed, Abeer E.S.; Rashad, Alaa A.; Desouky, Manar A. El; Dawabah, Mahmoud H.; Shaheen, Mohamed M. A.; Sherief, Heba Allah M.; Ibrahim, Mohamed A.; and El-Halim, Sohaila A Abd (2023) "Mortality rate among Preterm Infants with Respiratory Distress Syndrome on Non-Invasive Respiratory Support (NIRS): A ٌRetrospective multicenter study," Journal of Medicine in Scientific Research: Vol. 6: Iss. 1, Article 10.
DOI: https://doi.org/10.59299/2537-0928.1027