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PEDIATRICS Vol. 113 No. 6 June 2004, pp. e560-e563

ELECTRONIC ARTICLE

Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants <30 Weeks’ Gestation

Carlo Dani, MD, Giovanna Bertini, MD, Marco Pezzati, MD, Alessandra Cecchi, MD, Cosimo Caviglioli, MD and Firmino F. Rubaltelli, MD

From the Department of Surgical and Medical Critical Care, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy

Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).

Methods. A prospective randomized study was conducted, in which infants <30 weeks’ gestation were randomized to the SURF-NCPAP group or the SURF-MV group.

Results. At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.

Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit.

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Key Words: continuous positive airway pressure • mechanical ventilation • surfactant • respiratory distress syndrome • infant

Abbreviations: a/APO₂, arterial/alveolar oxygen tension ratio • iRDS, infant respiratory distress syndrome • MV, mechanical ventilation • NCPAP, nasal continuous positive airway pressure • SURF-MV, mechanical ventilation after surfactant treatment • SURF-NCPAP, nasal continuous positive airway pressure after surfactant treatment • FIO₂, fraction of inspired oxygen • IVH, intraventricular hemorrhage • BPD, bronchopulmonary dysplasia • ROP, retinopathy of prematurity • PDA, patent ductus arteriosus

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Received for publication Nov 10, 2003; Accepted Jan 28, 2004.

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