NIPPV and nBiPAP Methods in Preterm Infants With Respiratory Distress Syndrome

Study Overview
=================
Brief 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.

Detailed Description
-----------------
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 < 7.20 and PCO2 > 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.

Official Title
-----------------
Comparison of Nasal Intermittent Positive Airway Pressure and Nasal Bi-level Positive Airway Pressure Methods in Preterm Infants With Respiratory Distress Syndrome With Gestational Age of 26-30 Weeks

Conditions
-----------------
Prematurity, Respiratory Distress Syndrome

Intervention / Treatment
-----------------
* Device: noninvasive respiratory support devices


Participation Criteria
=================
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

Ages Eligible for Study
-----------------
Minimum Age: 1 Hour
Maximum Age: 3 Days

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: NIPPV<br>noninvasive respiratory support devices This group receiving Nasal Intermittent Positive Pressure Ventilation (NIPPV) treatment. | Device: noninvasive respiratory support devices<br> <br> |
| Active Comparator: BİPAP<br>noninvasive respiratory support devices This group receive Bi-Level Positive Airway Pressure (BIPAP) treatment. | Device: noninvasive respiratory support devices<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| surfactant requirement | surfactant requirement within the first 72 hours of life | 72 HOURS |