Investigating the Success Rate of Non-invasive Cycled-PAP in Managing Respiratory Distress Syndrome in Preterm Infants: A Clinical Trial Comparing NIPPV and Synchronized-NIPPV

Background: Currently, the application of continuous distending pressure (CDP) through non-invasive methods, combined with antenatal corticosteroid administration and surfactant replacement, is considered a crucial aspect of therapeutic strategies for neonates suffering from respiratory distress syndrome (RDS). However, treatment failure of nasal continuous positive airway pressure (nCPAP) in extremely preterm neonates poses significant challenges for both clinicians and patients. In response, research initiatives aimed at improving the effectiveness of this therapeutic approach have focused on non-invasive cycled positive airway pressure (cycled-PAP) modalities, such as non-invasive positive pressure ventilation (NIPPV) and synchronized NIPPV (SNIPPV), which have become a significant area of interest for researchers in the field. Objectives: Given the expanded use of dual-level pressure during respiratory support targeting CDP in RDS, now recognized as non-invasive ventilation (NIV) as a primary mode over the past two decades, synchronization with the infant's respiratory cycle has garnered attention. This study investigates whether synchronization of these two pressure levels with the respiratory cycle offers additional benefits compared to asynchronous dual pressure support for neonates with RDS. Methods: The present study is a randomized controlled trial (RCT) involving neonates with a gestational age of 28 - 32 weeks diagnosed with RDS. Following surfactant administration and nCPAP initiation, neonates were managed with either NIPPV or SNIPPV. The trial was conducted from August 2023 to September 2024 at Shahid Beheshti and Al-Zahra hospitals in Isfahan. Results and Conclusions: The findings revealed no significant difference between the two groups in the need for mechanical ventilation and multiple surfactant doses, the duration of non-invasive respiratory support, the incidence of chronic lung disease, rates of intraventricular hemorrhage (Grades III and IV), periventricular leukomalacia, pneumothorax, or mortality rate.