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RMJ. 2015; 40(2): 197-202

Nasal -IMV versus Nasal-CPAP as an initial mode of respiratory support for premature infants with RD: A prospective randomized clinical trial

Ghassan S.A. Salama, Fadi. F. Ayyash, Anas. J. Al-Rabadi, Mohammad L. Alquran, Ayoub G. Shakkoury.

Objective: This study aimed to compare nasal intermittent mandatory ventilation (N-IMV) versus nasal continuous positive airway pressure (N-CPAP) as an initial mode of respiratory support for premature infants with respiratory distress syndrome (RDS).
Method and patients : At Prince Hashem Ben Al- Hussein Military Hospital/ Jordan, a sixty premature infants born at gestational age 28-34 weeks with RDS, were divided into two equal groups: Group A: Connected through a nasal cannula to respirator using the IMV mode immediately after birth, and Group B:- Connected to bubble N-CPAP driver. Arterial blood gases (ABGs) were observed, and a daily chest x- rays were taken. All included infants evaluated clinically on a daily base, throughout the period of the study. Effect, failure, and complications of each method evaluated and compared.
Results: A total of 60 premature infants (32 males and 28 females) with gestational age 28- 34 weeks and birth weight 0.880- 2.0 kg were included. N-IMV associated with almost ideal physiological arterial gases (mean PaCO2=37.5mmHg, mean PaO2=82.5 mmHg, mean O2 sat=95%, mean pH=7.32 and mean HCO3=19.2mmol/l), where N-CPAP associated with CO2 retention and acidosis (mean PaCO2=53 mmHg and mean pH=7.23). Infants in the N-IMV group had less occurrence of pneumothorax, secondary chest infection , late sepsis, and bronchopulmonary dysplasia (BPD) meanwhile, gastrointestinal perforation and abdominal distention were common in N-CPAP group.
Conclusion: N-IMV associated to a more physiological arterial gases, no pneumothorax, and absence of abdominal complications and nasal deformity, all of which making it superior to N-CPAP.

Key words: Premature, surfactant, ventilation.

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