Effect of Lung Recruitment in the Efficacy of Intubation-Surfactant-Extubation Treatment of Respiratory Distress Syndrome in Preterm Neonates

Objectives: To compare the efficacy of lung recruitment versus conventional care in preterm neonates with respiratory distress syndrome in terms of reduction in requirement for mechanical ventilation. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Pediatrics, Combined Military Hospital, Rawalpindi Pakistan, Mar 2022 to Mar 2023. Methodology: We conducted this study on 246 preterm neonates with respiratory distress syndrome. Neonates in the intervention arm received lung recruitment therapy with a pressure of 25 cmH2O for 15 seconds during surfactant administration. Both groups were subsequently placed on continuous positive pressure airway ventilation, failure of which was said to have occurred if the patient was unable to maintain SpO2 despite increasing FiO2 with worsening respiratory acidosis and apneic spells, which resulted in intubation and mechanical ventilation. Results: A total of 246 premature neonates with a mean gestational age at birth of 31.88±2.42 weeks were studied. Requirements for mechanical ventilation were seen in 29.3% of those who received lung recruitment versus 43.1% of those without (p=0.024). The total number of complicated cases was significantly lower with lung recruitment: 8.9% versus 17.9% in those without recruitment (p=0.040); however, the frequency of individual complications like pneumothorax (p=0.213), intraventricular hemorrhage (p=0.281), necrotizing enterocolitis (p=0.327) and mortality (p=0.254) were not significantly different across the groups. Conclusion: Using lung recruitment with administration of surfactant therapy for premature neonates is associated with reduced requirement for mechanical ventilation, duration of mechanical ventilation, and a reduction in total frequency of complications.