Randomized crossover trial of four nasal respiratory support systems on apnoea of prematurity in very low birth weight infants

Abstract

Background: Apnoea of prematurity (AOP) is a common problem in preterm infants, which may be treated with various modes of nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV). It is unknown which mode of NCPAP or NIPPV is most effective for AOP.

Objective: To assess the effect of four NCPAP/NIPPV systems on the rate of bradycardias and desaturation events.

Methods: Sixteen infants (mean gestational age at study 31 weeks, 10 males) with AOP were enrolled in a randomized controlled trial with a cross-over design. They were allocated to receive nasal pressure support for 6 hours each, using four different modes: NIPPV via a conventional ventilator, NIPPV and NCPAP via a variable flow device, and NCPAP delivered via a constant flow Underwater Bubble System. Primary outcome was the cumulative event rate of bradycardias (≤ 80 beats per minute) and desaturation events (≤ 80% arterial oxygen saturation), which was obtained with cardio-respiratory recordings.

Results: The median event rate was 6.7 per hour with the conventional ventilator in NIPPV mode, and 2.8 and 4.4 per hour with the variable flow device in NCPAP and NIPPV mode, respectively (p-value < 0.03 for both compared to NIPPV/conventional ventilator). There was no significant difference between the NIPPV/conventional ventilator and the Underwater Bubble System.

Conclusion: A variable flow NCPAP device may be more effective in treating AOP in preterm infants than a conventional ventilator in NIPPV mode It remains unclear wether sychronized NIPPV would be even more effective.