Comparison between nasal continuous positive airway pressure and mechanical ventilation after surfactant administration in preterm neonates with respiratory distress syndrome

Background Preterm birth continues to be one of the major challenges in perinatal medicine. Prematurity and its associated complications are associated with high morbidity and mortality. Respiratory distress (RD) is the single major cause of illness and death in preterm infants.Aim The aim of this study was to evaluate the outcomes of the use of nasal continuous positive airway pressure (NCPAP) compared with invasive mechanical ventilation (MV) after surfactant administration in preterm neonates with RD syndrome.Patients and methods This randomized controlled clinical study was conducted on 82 preterm neonates with gestational age 28–34 weeks with RD secondary to RD syndrome. Patients were randomized into two groups: 41 received NCPAP and 41 received MV following surfactant administration. The primary outcome was improvement of oxygenation parameters and the need for MV between study enrollment till hospital discharge. Secondary outcomes included incidence of pneumothorax, intraventricular hemorrhage (IVH), patent ductus arteriosus, late-onset sepsis, bronchopulmonary dysplasia, days of oxygen therapy, days of MV, and length of hospital stay.Results Only 26.8% of neonates who received NCPAP needed MV. The application of NCPAP immediately after surfactant administration was significantly associated with a lower incidence of complications, namely, pneumothorax (7.3 vs. 36.6%) and IVH (17.1 vs. 41.5%). There was no significant difference between studied groups regarding the duration of hospital stay, incidence of late onset sepsis, ventilator-associated pneumonia, and patent ductus arteriosus.Conclusion The application of NCPAP immediately after surfactant administration reduces the need for MV, with a resulting lower incidence of complications such as pneumothorax and IVH.