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  • Original Article
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Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial

Journal of Perinatology volume 35, pages 935–940 (2015)Cite this article

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Abstract

Objective:

To compare the failure rates between Jet continuous positive airway pressure device (J-CPAP-variable flow) and Bubble continuous positive airway device (B-CPAP) in preterm infants with respiratory distress.

Study design:

Preterm newborns <34 weeks gestation with onset of respiratory distress within 6 h of life were randomized to receive J-CPAP (a variable flow device) or B-CPAP (continuous flow device). A standardized protocol was followed for titration, weaning and removal of CPAP. Pressure was monitored close to the nares in both the devices every 6 hours and settings were adjusted to provide desired CPAP. The primary outcome was CPAP failure rate within 72 h of life. Secondary outcomes were CPAP failure within 7 days of life, need for surfactant post-randomization, time to CPAP failure, duration of CPAP and complications of prematurity. An intention to treat analysis was done.

Results:

One-hundred seventy neonates were randomized, 80 to J-CPAP and 90 to B-CPAP. CPAP failure rates within 72 h were similar in infants who received J-CPAP and in those who received B-CPAP (29 versus 21%; relative risks 1.4 (0.8 to 2.3), P=0.25). Mean (95% confidence intervals) time to CPAP failure was 59 h (54 to 64) in the Jet CPAP group in comparison with 65 h (62 to 68) in the Bubble CPAP group (log rank P=0.19). All other secondary outcomes were similar between the two groups.

Conclusion:

In preterm infants with respiratory distress starting within 6 h of life, CPAP failure rates were similar with Jet CPAP and Bubble CPAP.

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References

  1. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK . Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971; 284 (24): 1333–1340.

    Article  CAS  Google Scholar 

  2. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21): 1970–1979.

    Article  CAS  Google Scholar 

  3. Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011; 128 (5): e1069–e1076.

    Article  Google Scholar 

  4. De Paoli AG, Davis PG, Faber B, Morley CJ . Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev. 2008, Issue 1. Art No.: CD002977. doi:10.1002/14651858.CD002977.pub2.

  5. Benveniste D, Pedersen JE . A valve substitute with no moving parts, for artificial ventilation in newborn and small infants. Br J Anaesth 1968; 40 (6): 464–470.

    Article  CAS  Google Scholar 

  6. Theilade D . Nasal CPAP employing a jet device for creating positive pressure. Intensive Care Med 1978; 4 (3): 145–148.

    Article  CAS  Google Scholar 

  7. Klausner JF, Lee AY, Hutchison AA . Decreased imposed work with a new nasal continuous positive airway pressure device. Pediatr Pulmonol 1996; 22 (3): 188–194.

    Article  CAS  Google Scholar 

  8. Pandit PB, Courtney SE, Pyon KH, Saslow JG, Habib RH . Work of breathing during constant- and variable-flow nasal continuous positive airway pressure in preterm neonates. Pediatrics 2001; 108 (3): 682–685.

    Article  CAS  Google Scholar 

  9. Mazzella M, Bellini C, Calevo MG, Campone F, Massocco D, Mezzano P et al. A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 85 (2): F86–F90.

    Article  CAS  Google Scholar 

  10. Liptsen E, Aghai ZH, Pyon KH, Saslow JG, Nakhla T, Long J et al. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices. J Perinatol. 2005; 25 (7): 453–458.

    Article  Google Scholar 

  11. Ahluwalia JS, White DK, Morley CJ . Infant Flow Driver or single prong nasal continuous positive airway pressure: short-term physiological effects. Acta Paediatr 1998; 87 (3): 325–327.

    Article  CAS  Google Scholar 

  12. Wald M, Kribs A, Jeitler V, Lirsch D, Pollak A, Kirchner L . Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants. Artif Organs 2011; 35 (1): 22–28.

    Article  Google Scholar 

  13. Bober K, Swietlinski J, Zejda J, Kornacka K, Pawlik D, Behrendt J et al. A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very low birth weight infants. Pediatr Crit Care Med 2012; 13: 191–196.

    Article  Google Scholar 

  14. Jaile JC, Levin T, Wung JT, Abramson SJ, Ruzal-Shapiro C, Berdon WE . Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. AJR Am J Roentgenol 1992; 158 (1): 125–127.

    Article  CAS  Google Scholar 

  15. Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1): 92–100.

    Article  CAS  Google Scholar 

  16. Downes JJ, Vidyasagar D, Boggs TR Jr, Morrow GM 3rd . Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr (Phila) 1970; 9: 325–331.

    Article  CAS  Google Scholar 

  17. Gupta S, Sinha SK, Tin W, Donn SM . A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus Infant Flow Driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr 2009; 154 (5): 645–650.

    Article  Google Scholar 

  18. Koti J, Murki S, Gaddam P, Reddy A, Reddy MD . Bubble CPAP for respiratory distress syndrome in preterm infants. Indian Pediatr 2010; 47 (2): 139–143.

    Article  Google Scholar 

  19. Yagui AC, Vale LA, Haddad LB, Prado C, Rossi FS, Deutsch AD et al. Bubble CPAP versus CPAP with variable flow in newborns with respiratory distress: a randomized controlled trial. J Pediatr (Rio J) 2011; 87 (6): 499–504.

    Article  Google Scholar 

  20. Stefanescu B, Murphy WP, Hansell BJ, Fuloria M, Morgan TM, Aschner JL . A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics 2003; 112: 1031–1038.

    Article  Google Scholar 

  21. Pillow JJ, Travadi JN . Bubble CPAP: is the noise important? An in vitro study. Pediatr Res 2005; 57 (6): 826–830.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Neonatal Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    A Bhatti, V Sundaram, S S Saini & P Kumar

  2. Neonatal Unit, Fernandez Hospital,, Hyderabad, India

    J Khan & S Murki

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  1. A Bhatti
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Correspondence to P Kumar.

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Bhatti, A., Khan, J., Murki, S. et al. Nasal Jet-CPAP (variable flow) versus Bubble-CPAP in preterm infants with respiratory distress: an open label, randomized controlled trial. J Perinatol 35, 935–940 (2015). https://doi.org/10.1038/jp.2015.98

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