The Turkish Journal of Pediatrics
2012 , Vol 54 , Num 6
Randomized Controlled Trial of Two Methods of Nasal Continuous Positive Airway Pressure (N-CPAP) in Preterm Infants with Respiratory Distress Syndrome: Underwater Bubbly CPAP vs. Medijet System Device
Departments of 1Neonatology and Pediatric Health Research Center, 2Physiology, 3Student Research Committee, 4Publication
Office, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail: alikhah@tbzmed.ac.ir
There has been an increasing interest in the application of non-invasive
respiratory support in preterm infants, and different types of nasal continuous
positive airway pressure (N-CPAP) devices are being used in Neonatal Intensive
Care Units (NICUs). The objective of the present study was to compare
the duration of CPAP need and possible complications of two methods
of (N-CPAP) delivery: Bubble CPAP (B-CPAP) and Medijet (MJ) system
device in preterm infants with respiratory distress syndrome (RDS). This
prospective randomized clinical trial was performed on 161 preterm infants
(28-37 weeks of gestational age) with RDS and eligible for CPAP therapy. The
infants were inborn and admitted in a level III NICU of Al-Zahra Teaching
Hospital (Tabriz, Iran) from April 2010 to September 2011. All infants were
randomized in the first hour of life to B-CPAP or MJ system. Short binasal
prongs were used in both groups and CPAP was set at the level of 5-6 cm
H2O. The primary outcome of this study was duration of CPAP need (hour).
Other outcomes, such as complications of the two methods of N-CPAP,
were evaluated using a checklist. Ninety infants were randomized to the MJ
system, and 71 were randomized to B-CPAP. The mean gestational age and
birth weight were similar in the two groups, as was the duration of CPAP
need (44.3±20.64 vs. 49.2±21.2 hours, respectively; p=0.66). Moreover, the
probability of complications, such as CPAP failure rate, pulmonary hemorrhage,
pneumothorax, intraventricular hemorrhage, abdominal distention, necrotizing
enterocolitis, and bronchopulmonary dysplasia, was the same between the
two study groups (p>0.05). There was a trend of more hyperemia of the
nose in the B-CPAP group in comparison to the MJ system group (10%
versus 3.3%, respectively), but the difference was not significant (p=0.08).
In conclusion, the MJ system is as effective as B-CPAP in the management
of infants with RDS.
Keywords :
continuous positive airway pressure, mechanical ventilation, preterm
infants, respiratory distress syndrome.