eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
3/2019
vol. 15
 
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Neonatology
abstract:
Clinical research

Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome

Nesrin M. Handoka, Mona Azzam, Ayman Gobarah

Arch Med Sci 2019; 15 (3): 680–687
Online publish date: 2019/02/18
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Introduction
The current trend in management of preterm neonates with respiratory distress syndrome is to attempt noninvasive ventilation (NIV) to avoid endotracheal intubation. However, failure of noninvasive ventilation may lead to increased morbidity and mortality. There is a scarcity of studies establishing predictors for the usefulness of NIV in this age group. Our aim here was to determine the predictors of NIV in preterm infants with respiratory distress syndrome (RDS) treated with synchronized nasal intermittent positive pressure ventilation (SNIPPV) for initial respiratory support.

Material and methods
We conducted a follow-up study on 85 infants < 32 weeks of gestational age, and < 1500 g with RDS who received early SNIPPV. Perinatal history, physical characteristics, ventilatory settings, and arterial blood gas analysis results were collected. We recorded the failure rate and potential predictive factors of this failure.

Results
There were 12 (14.1%) patients who had SNIPPV failure. The SNIPPV failure group had multiple significantly different characteristics compared to the successful SNIPPV group including gestation age, birth weight, grading of disease, severity of respiratory distress, antenatal steroid use and various ventilatory settings. Further multivariate analysis revealed only 3 predictors in our patients: grade of RDS (OR = 4.48, p = 0.008), antenatal steroid use (OR = 1.09, p = 0.01) and mean airway pressure (OR = 1.98, p = 0.0001).

Conclusions
Failure of early NIV occurred in a small subset of our patients. Predictors of noninvasive ventilation failure may be a useful guide for decisions regarding intubation.

keywords:

preterm infants, predictors, respiratory distress syndrome, synchronized nasal intermittent positive pressure ventilation failure

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