nippv and nbipap methods in preterm infants with respiratory distress syndrome

Conditions: Prematurity; Respiratory Distress Syndrome

Summary: purpose is to compare introduction of nippv (nasal intermittent positive-pressure ventilation) and nbipap (nasal bi-level positive airway pressure) in terms of mechanical ventilation (mv) need (non-invasive respiratory support failure) and surfactant need within the first 72 hours of life in preterm infants with respiratory distress syndrome (rds) at 26-30 weeks of gestation.

purpose is to compare introduction of nippv and nbipap in terms of mechanical ventilation (mv) need (non-invasive respiratory support failure) and surfactant need within the first 72 hours of life in preterm infants with respiratory distress syndrome (rds) at 26-30 weeks of gestation. method primary outcome measures: in nippv and bipap groups, comparison of mechanical ventilation (mv) need (non-invasive respiratory support failure) and surfactant need within the first 72 hours of life secondary outcome measures: * compare patients' need of total duration of invasive and non-invasive respiratory support and the duration of free oxygen * compare oxygen need in postnatal day 28 and week 36 * compare the presence and severity of bpd (bronchopulmonary dysplasia) * compare premature morbidities such as pda (patent ductus arteriosus), ivh (intraventricular haemorrhage), nec (necrotizing enterocolitis), rop (retinopathy of prematurity) * compare feeding intolerance, reaching birth weight and transition to full oral feeding time, hospitalization period * compare their neurodevelopment in postnatal age 2 study design in nippv group; non-synchronous mode will be used, and they will be titrated between fio2: 021-0.50 in a respiratory rate of 20-40 / min, peak inspiratory pressure (pip): 15-20 end-expiratory pressure (peep):5-6 cm h2o and target oxygen saturation: 90-95 %. in nbipap group; they will be titrated between 021-0.50, in non-synchronized peep:6 h2o, pressure amplitude: 3 cm h2o, fio2 target oxygen saturation of 90-95 %. under non-invasive respiratory support, in case of fio2 is ≥ 0.40, surfactant will be given as early rescue therapy by means of non-invasive method (by using a thin catheter - take care method- while spontaneous breathing continues) in order to keep target oxygen saturation between 90-95 %. the second dose of surfactant will be given 6 hours after the first dose by means on non-invasive method in order to keep target oxygen saturation between 90-95 % in case of fio2 need is ≥ 0.30. non-invasive respiratory support failure is set as follows: * fio2 of ≥ 0.50 in order to keep oxygen saturation measured by pulse oximetry above 90 % and higher, * apnea requiring more than 6 alerts in a 24 -hour period in 6 consecutive hours or more than 1 apnea requiring positive pressure ventilation, * persistent acidosis; presence of ph \ 65 mmhg in two different blood gases drawn with an interval of at least 30 minutes or treatment-resistant metabolic acidosis, * severe respiratory distress, * pulmonary haemorrhage and cardiopulmonary arrest.

Eligibility criteria:
inclusion criteria: * preterm infant with gestational age of 26 weeks 0 days and 29 weeks 6 days will be included. exclusion criteria: * major congenital anomalies * presence of cardiovascular instability * intubation at admission to the nicu * consent not provided or refused