Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital

Abstract Background:Respiratory distress syndrome remains an important cause of neonatal mortality and morbidity worldwide. Early initiation of continuous positive airway pressure is a standard of care for preterm infants with respiratory distress syndrome. Positive end-expiratory pressure reduces the need for invasive ventilation and prevents chronic lung disease. However, the optimum positive end expiratory pressure level to effectively treat respiratory distress syndrome in preterm infants remains unknown. Objective: To determine the optimal initial positive end expiratory pressure level in management of preterm infants with respiratory distress syndrome. Methods:This prospective descriptive study was conducted from July 2023 to January 2024 in the newborn unit of Moi Teaching and Referral Hospital. A total of 204 preterm infants (28-34 weeks gestational age) with respiratory distress syndrome who required Continuous Positive Airway Pressure treatment were recruited. Data on the maternal and neonatal characteristics, low and high positive end expiratory pressure levels, and outcomes at 72 hours were collected and analysed. Descriptive statistics were used for continuous variables, and frequencies were used for categorical data. A p value less than 0.05 was considered statistically significant at the 95% confidence interval. Receiver operating characteristic curves were used to determine the optimal positive end expiratory pressure level. Results:A total of 45 and 159 preterm infants were started on low and high positive end expiratory pressure levels, respectively. Among 159 (77.9%) of the preterm infants started on high positive end expiratory pressure levels, majority (135, 66.2%) were initiated at a positive end expiratory pressure level of 6 cmH2O. The Area under the curve for low positive end expiratory pressure levels was 0.5757 and the one for high positive end expiratory pressure levels was 0.5405. DeLong's test for two ROC curves D = 0.82979, df = 120.8, p value = 0.4083. The area under the curve of both low and high positive end expiratory pressure levels were close and not significantly different (p=0.4083). Conclusion: In this study, low positive end expiratory pressure was associated with low failure rate and complications. However low and high positive end expiratory pressure levels were not significantly different to determine the optimal initial PEEP. The optimal positive end expiratory pressure level for continuous positive airway pressure initiation in preterm infants with respiratory distress syndrome could not be determined because of the small sample size