Noninvasive Ventilation in Newborns ≤ 1,500 g after Tracheal Extubation: Randomized Clinical Trial

Simone Nascimento Santos Ribeiro; Maria Jussara Fernandes Fontes; Vineet Bhandari; Camilla Borges Resende; Cintia Johnston

doi:10.1055/s-0037-1602141

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(12): 1190-1198
DOI: 10.1055/s-0037-1602141

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Noninvasive Ventilation in Newborns ≤ 1,500 g after Tracheal Extubation: Randomized Clinical Trial

Authors

Simone Nascimento Santos Ribeiro

¹Section of Physiotherapy, Hospital Sofia Feldman, Belo Horizonte, MG, Brazil
Maria Jussara Fernandes Fontes

²Department of Medicine, Federal University Minas Gerais, Belo Horizonte, MG, Brazil
Vineet Bhandari

³Section of Neonatology, St. Christopher's Hospital for Children/Drexel University, Philadelphia, Pennsylvania
Camilla Borges Resende

⁴Respiratory Care, Belo Horizonte, MG, Brazil
Cintia Johnston

⁵Respiratory Care, Department of Pediatrics, Federal University São Paulo, São Paulo, Brazil

Abstract

Objective Our aim was to compare the success of extubation in neonates managed with nonsynchronized intermittent nasal positive-pressure ventilation (nsNIPPV) and two modes of nasal continuous positive airway pressure (NCPAP) after the first extubation.

Study Design Randomized controlled clinical trial conducted in the neonatal intensive care unit (NICU) included infants with gestational age ≤ 34 weeks and birth weights (BW) 500 to 1,500 g with a diagnosis of respiratory distress syndrome (RDS), divided into three groups: ventilation with nsNIPPV, bubble-NCPAP, and ventilator-NCPAP. Extubation failure (EF) was defined as occurring within 48 hours after extubation.

Results We included 101 newborns: nsNIPPV (n = 36); bubble-NCPAP (n = 32) ventilator-NCPAP (n = 33). Overall, the extubation success rate was 81.2%. There were no skin, gastric, or pulmonary complications related to noninvasive ventilation (NIV) (p = 1). There was no difference between the groups regarding the success/EF (p = 0.4). There was extubation success in 81 (81.2%) cases, and EF occurred in 20 (19.8%), associated with longer invasive mechanical ventilation time (p < 0.001) and development of bronchopulmonary dysplasia (p = 0.04).

Conclusion In this trial, three modalities of NIV applied in the success/failure outcomes of extubation avoided reintubation in 80% of infants.

Keywords

newborn - preterm - extubation - noninvasive ventilation - respiratory distress syndrome

Full Text

References

References
1 Blencowe H, Cousens S, Oestergaard MZ. , et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832): 2162-2172
2 Lawn JE, Davidge R, Paul VK. , et al. Born too soon: care for the preterm baby. Reprod Health 2013; 10 (Suppl. 01) S5.
3 Roberts CT, Davis PG, Owen LS. Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?. Neonatology 2013; 104 (03) 203-209
4 Sweet DG, Carnielli V, Greisen G. , et al; European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants—2013 update. Neonatology 2013; 103 (04) 353-368
5 Liptsen E, Aghai ZH, Pyon KH. , et al. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices. J Perinatol 2005; 25 (07) 453-458
6 Gupta S, Sinha SK, Tin W, Donn SM. A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus infant flow driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr 2009; 154 (05) 645-650
7 Friedman CA, Menchaca RC, Baker MC. , et al. Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations. Respir Care 2013; 58 (07) 1134-1142
8 Kawaza K, Machen HE, Brown J. , et al. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi. PLoS One 2014; 9 (01) e86327
9 De Paoli AG, Morley C, Davis PG. Nasal CPAP for neonates: what do we know in 2003?. Arch Dis Child Fetal Neonatal Ed 2003; 88 (03) F168-F172
10 Polin RA, Carlo WA. ; Committee on Fetus and Newborn; American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 2014; 133 (01) 156-163
11 Klein JM. Guidelines for surfactant administration (surfactant replacement therapy) [Internet]. Iowa City, Iowa: University of Iowa Stead Family Children's Hospital; 2017 [citado em: 2017 Mar 10]. Disponível em: https://uichildrens.org/health-library/guidelines-surfactant-administration-surfactant-replacement-therapy
12 Carvalho WB, Johnston C, Barbosa AP. , et al. Consenso ventilação pulmonar mecânica em pediatria/neonatal: Ventilação não invasiva com pressão positiva—VNIPP. São Paulo, Brazil: AMIB; 2009
13 Vaucher YE, Peralta-Carcelen M, Finer NN. , et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med 2012; 367 (26) 2495-2504
14 Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17 (04) 213-288
15 The Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol 1984; 102 (08) 1130-1134
16 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
17 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
18 Buzzella B, Claure N, D'Ugard C, Bancalari E. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants. J Pediatr 2014; 164 (01) 46-51
19 Giaccone A, Jensen E, Davis P, Schmidt B. Definitions of extubation success in very premature infants: a systematic review. Arch Dis Child Fetal Neonatal Ed 2014; 99 (02) F124-F127
20 Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012; 11 (11) CD001456
21 Ramanathan R, Sekar KC, Rasmussen M, Bhatia J, Soll RF. Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks' gestation: a randomized, controlled trial. J Perinatol 2012; 32 (05) 336-343
22 Thomas PE. Do racial disparities persist in infant mortality from respiratory distress syndrome?. J Obstet Gynecol Neonatal Nurs 2011; 40 (01) 47-51
23 Kumar M, Avasthi S, Ahuja S, Malik GK, Singh SN. Unsynchronized nasal intermittent positive pressure ventilation to prevent extubation failure in neonates: a randomized controlled trial. Indian J Pediatr 2011; 78 (07) 801-806
24 Meneses J, Bhandari V, Alves JG, Herrmann D. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatrics 2011; 127 (02) 300-307
25 Kahramaner Z, Erdemir A, Turkoglu E, Cosar H, Sutcuoglu S, Ozer EA. Unsynchronized nasal intermittent positive pressure versus nasal continuous positive airway pressure in preterm infants after extubation. J Matern Fetal Neonatal Med 2014; 27 (09) 926-929
26 Bahman-Bijari B, Malekiyan A, Niknafs P, Baneshi MR. Bubble-CPAP vs. ventilatory-CPAP in preterm infants with respiratory distress. Iran J Pediatr 2011; 21 (02) 151-158
27 Khorana M, Paradeevisut H, Sangtawesin V, Kanjanapatanakul W, Chotigeat U, Ayutthaya JK. A randomized trial of non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV) vs. nasal continuous positive airway pressure (NCPAP) in the prevention of extubation failure in pre-term < 1,500 grams. J Med Assoc Thai 2008; 91 (Suppl. 03) S136-S142
28 Yadav S, Thukral A, Sankar MJ. , et al. Bubble vs conventional continuous positive airway pressure for prevention of extubation failure in preterm very low birth weight infants: a pilot study. Indian J Pediatr 2012; 79 (09) 1163-1168
29 Bhandari V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J Perinatol 2010; 30 (08) 505-512
30 Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS. ; NIPPV Study Group. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med 2013; 369 (07) 611-620
31 Meneses J, Bhandari V, Alves JG. Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012; 166 (04) 372-376
32 Bhandari V. Noninvasive respiratory support in the preterm infant. Clin Perinatol 2012; 39 (03) 497-511
33 Bhandari V. The potential of non-invasive ventilation to decrease BPD. Semin Perinatol 2013; 37 (02) 108-114
34 Mehta P, Berger J, Bucholz E, Bhandari V. Factors affecting nasal intermittent positive pressure ventilation failure and impact on bronchopulmonary dysplasia in neonates. J Perinatol 2014; 34 (10) 754-760
35 Jasani B, Nanavati R, Kabra N, Rajdeo S, Bhandari V. Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med 2016; 29 (10) 1546-1551
36 Chen L, Wang L, Li J, Wang N, Shi Y. Noninvasive ventilation for preterm twin neonates with respiratory distress syndrome: a randomized controlled trial. Sci Rep 2015; 5