Comparison of Nasal Non-invasive Ventilation Methods in Preterm Neonates with Respiratory Distress Syndrome

Background: Humidified heated high flow nasal cannula (HHHFNC), nasal continuous positive airway pressure (NCPAP), and nasal intermittent positive pressure ventilation (NIPPV) are three nasal non-invasive ventilation methods. The purpose of this study was to compare these three methods in decreasing intubation and mechanical ventilation rate in preterm neonates with respiratory distress syndrome (RDS). Methods: This study was a randomized controlled study conducted on 160 neonates. The inclusion criteria for intubation in this study were persistent respiratory acidosis (arterial pH<7/2 or PCO2>60), hypoxemia, severe and repeated apnea episodes which did not respond to increasing respiratory rate and therefore required ventilation. Cranial Ultrasound was performed on the third day after birth. The data of all neonates were collected until the day of discharge and analyzed by SPSS (version 20) and statistical methods. Results: Based on the results, there was no significant difference among the three randomized methods. Out of all the cases, 72% of the neonates with NIPPV had successful non-invasive ventilation (35/53), compared to 73/6% in NCPAP (39/53) and 72/2% in HHHFNC (P=0/999). Similarly, there was no significant difference among the three methods in total ventilation time and the need for supplemental oxygen. Conclusion: The use of HHHFNC at birth in preterm neonates with RDS is safer than the other two methods. However, it is not more effective than the other two methods in the reduction of intubation rate.