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CompletedNCT03347136Updated Nov 20, 2017

Comparison of Continuous Positive Airway Pressure and Non Invasive Positive Pressure Ventilation

An interventional study of CPAP and NIPPV in Respiratory Distress of Newborn, sponsored by Ministry of Health, Sri Lanka. Completed at 1 site in Sri Lanka. Open to participants aged 20 Minutes to 24 Hours. Per ClinicalTrials.gov, last updated 2017-11-20.

Sponsored by Ministry of Health, Sri Lanka · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
80
Allocation
Randomized
Ages
20 Minutes to 24 Hours
Sex
All
01

Study summary

The objective of the study is to compare the effectiveness of treatment with Non Invasive Positive Pressure Ventilation (NIPPV) and continuous positive airway pressure (CPAP) in decreasing the requirement for endotracheal ventilation in neonates with respiratory distress within the first hours of birth.Primary outcome is the non invasive respiratory support failure and the need for intubated ventilatory support during the first 72 hours of life.

Randomized control , single center trial. Eighty neonates admitted to Neonatal Intensive Care Unit (NICU) were randomly allocated to NIPPV and CPAP. Outcomes of respiratory support were observed and information on risk factors were obtained by going through bed head ticket.

Read the detailed description

Objective of the study:

To compare the effectiveness of CPAP and NIPPV in neonates with mild to moderate respiratory distress.

Specific objectives To determine the effectiveness of CPAP and NIPPV in neonates with mild to moderate respiratory distress To describe neonatal factors associated with CPAP and NIPPV support. To compare the length of hospital stay in neonates who received CPAP and NIPPV To compare the time taken to achieve full enteral nutrition in neonates who received CPAP and NIPPV.

Study design:

Randomized controlled trial

Study setting:

Study carried out in NICU of the Sri Jayawardanapura General Hospital There are 06 ventilators in NICU of Sri Jayawardanapura Hospital. (Three SLE 2000 infant ventilators and three Bear CUB 750 psv infant ventilators.) Respiratory support (conventional ventilation, CPAP and NIPPV) gave through these ventilators. The neonatal soft tip curved nasal canula with tubing will be use for non invasive respiratory support. The nasal canula connected to the ventilator via an endotracheal tube connector. Systems were regularly monitored. Canula size was chosen to comfortably fit the infant's nostrils.

CPAP started with Positive end expiratory pressure (PEEP) 05 and increased up to PEEP 09 according to the severity of baby's condition.

NIPPV started with intermittent Mandatory ventilation (IMV) rate 30, peak inspiratory pressure (PIP) 20 and PEEP 5.Increased the settings according to the severity of baby's condition.

Sampling Method. All neonates fulfilling inclusion and exclusion criteria registered in the study. And a serial number issued. They were allocated to the two arms of study randomly based on a previously generated random allocation schedule.

They were managed according to hospital management protocol and outcome data were collected from the bed head ticket.

The ethical approval taken from the Ethical Review Committee of Sri Jayawardenepura General Hospital kotte.

Approval taken from Medical Technology and supplies sub committee on clinical trials Written informed consent obtained from parents or guardians of eligible infants before randomization The data sheets did not contain the name and be anonymous. Data stored under lock and key with restricted access only to the principal investigators. The computerized data were password protected and is only available to the investigators.

02

Conditions studied

03

Who can participate

Ages eligible
20 Minutes to 24 Hours
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

All neonates with mild to moderate respiratory distress, requiring non invasive respiratory support on admission as defined by one or more of the following

  1. Respiratory distress needing 3L of O2 to maintain saturation of >90%
  2. Silverman Anderson score of 4 - 6
  3. Apnoea

    1. >2 apnoeic attacks needing tactile stimulation for recovery.
    2. One apnoea needs resuscitation

Exclusion criteria

Exclusion Criteria:

  1. Major congenital anomalies
  2. Presence of cardiovascular instability {sepsis, anemia or severe intraventricular haemorrhage (IVH)}.
  3. Intubation needed on admission to the NICU
  4. Consent not provided or refused
  5. Major cardiac disease (not including patent ductus arteriosus [PDA]),

    -

04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
80 participants (actual)

Study arms

  • Active comparator
    Newborns with CPAP support

    Newborn with mild to moderate respiratory distress randomly allocated to CPAP arm. CPAP started with Positive End Expiatory Pressure(PEEEP) 05 and increased up to PEEP 09 according to the severity of baby's condition.

    Device: CPAP

  • Experimental
    Newborns with NIPPV support

    Newborn with mild to moderate respiratory distress randomly allocated to NIPPV arm. NIPPV started with Intermittent Mandatory Ventilation rate 30, Peak Inspiratory Pressure 20 and PEEP 5.Increased the settings according to the severity of baby's condition

    Device: NIPPV

Interventions

  • DeviceCPAP
  • DeviceNIPPV
05

What researchers measure

Primary outcomes

  1. Non invasive respiratory support failure

    Failure of non invasive respiratory support by requirement for endotracheal ventilation with in 72 hours of starting treatment.

    Time frame: 72 hours

Secondary outcomes

  1. duration of respiratory support

    Time in days to stop oxygen support and the neonate to be on room air without respiratory distress or apnoea.

    Time frame: 21 days

  2. length of hospital stay

    The total duration of hospital stay in days.

    Time frame: 28 days

  3. Grade III and IV Intra Ventricular Haemorrhage (IVH)

    Evidence of grade III or IV IVH from ultrasound scan of the brain.

    Time frame: 14 days

  4. time taken to achieve full enteral nutrition

    Total time in days the neonate will receive total enteral feed without intravenous fluid.

    Time frame: 21 days

06

Study locations

1 site
  • Sri Jayawardanapura teaching hospital
    Colombo, Western 10100, Sri Lanka
07

References and documents

Publications

  • DK Guha, editors, Jaypee Brothers. NNF Recommended Basic Perinatal-Neonatal Nomenclature. Neonatology- Principles and Practice. 1st ed. New Delhi, 1998: 131-2
  • J Crowther ANNP Updated by Dr Smith. East Cheshire NHS trust Endotracheal Intubation guide line February 2013 Version 2.0 3
  • Bhandari V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J Perinatol. 2010 Aug;30(8):505-12. doi: 10.1038/jp.2009.165. Epub 2009 Oct 22. Erratum In: J Perinatol. 2010 Dec;30(12):827. PubMed 19847188 ↗
  • Perinatal society of Sri Lanka in collaborating with WHO collaborating centre for training and research in new born care, All India Institute of Medical Science.Work book on neonatal ventilation.Learner's guide April 2008.
  • Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics. 2001 Jul;108(1):13-7. doi: 10.1542/peds.108.1.13. PubMed 11433048 ↗
  • Santin R, Brodsky N, Bhandari V. A prospective observational pilot study of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a primary mode of ventilation in infants > or = 28 weeks with respiratory distress syndrome (RDS). J Perinatol. 2004 Aug;24(8):487-93. doi: 10.1038/sj.jp.7211131. PubMed 15141265 ↗
  • Lin CH, Wang ST, Lin YJ, Yeh TF. Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity. Pediatr Pulmonol. 1998 Nov;26(5):349-53. doi: 10.1002/(sici)1099-0496(199811)26:53.0.co;2-7. PubMed 9859905 ↗
  • Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics. 2001 Apr;107(4):638-41. doi: 10.1542/peds.107.4.638. PubMed 11335736 ↗
  • De Paoli AG, Davis PG, Lemyre B. Nasal continuous positive airway pressure versus nasal intermittent positive pressure ventilation for preterm neonates: a systematic review and meta-analysis. Acta Paediatr. 2003;92(1):70-5. doi: 10.1111/j.1651-2227.2003.tb00472.x. PubMed 12650303 ↗
  • Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev. 2017 Feb 1;2(2):CD003212. doi: 10.1002/14651858.CD003212.pub3. PubMed 28146296 ↗
  • Meneses J, Bhandari V, Alves JG, Herrmann D. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatrics. 2011 Feb;127(2):300-7. doi: 10.1542/peds.2010-0922. Epub 2011 Jan 24. PubMed 21262883 ↗
  • Sai Sunil Kishore M, Dutta S, Kumar P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatr. 2009 Sep;98(9):1412-5. doi: 10.1111/j.1651-2227.2009.01348.x. Epub 2009 Jun 12. PubMed 19523049 ↗
  • Meneses J, Bhandari V, Alves JG. Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2012 Apr;166(4):372-6. doi: 10.1001/archpediatrics.2011.1142. PubMed 22474063 ↗
  • Roberts CT, Davis PG, Owen LS. Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013? Neonatology. 2013;104(3):203-9. doi: 10.1159/000353448. Epub 2013 Aug 28. PubMed 23989138 ↗
  • Claure N, Bancalari E. New modes of mechanical ventilation in the preterm newborn: evidence of benefit. Arch Dis Child Fetal Neonatal Ed. 2007 Nov;92(6):F508-12. doi: 10.1136/adc.2006.108852. Epub 2007 Sep 5. No abstract available. PubMed 17804519 ↗
  • Kugelman A, Feferkorn I, Riskin A, Chistyakov I, Kaufman B, Bader D. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study. J Pediatr. 2007 May;150(5):521-6, 526.e1. doi: 10.1016/j.jpeds.2007.01.032. PubMed 17452229 ↗
  • Lemyre B, Laughon M, Bose C, Davis PG. Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants. Cochrane Database Syst Rev. 2016 Dec 15;12(12):CD005384. doi: 10.1002/14651858.CD005384.pub2. PubMed 27976361 ↗
  • Bisceglia M, Belcastro A, Poerio V, Raimondi F, Mesuraca L, Crugliano C, Corapi UP. A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants. Minerva Pediatr. 2007 Apr;59(2):91-5. PubMed 17404558 ↗
  • Ramanathan R, Sekar KC, Rasmussen M, Bhatia J, Soll RF. Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks' gestation: a randomized, controlled trial. J Perinatol. 2012 May;32(5):336-43. doi: 10.1038/jp.2012.1. Epub 2012 Feb 2. Erratum In: J Perinatol. 2012 May;32(5):395. PubMed 22301528 ↗
  • Armanian AM, Badiee Z, Heidari G, Feizi A, Salehimehr N. Initial Treatment of Respiratory Distress Syndrome with Nasal Intermittent Mandatory Ventilation versus Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial. Int J Prev Med. 2014 Dec;5(12):1543-51. PubMed 25709790 ↗
  • Wood FE, Gupta S, Tin W, Sinha S. Randomised controlled trial of synchronised intermittent positive airway pressure (SiPAP) versus continuous positive airway pressure (CPAP) as a primary mode of respiratory support in preterm infants with respiratory distress syndrome. Archives of Disease in Childhood 2013;98(Suppl 1):A1-117.
  • Lista G, Castoldi F, Fontana P, Daniele I, Cavigioli F, Rossi S, Mancuso D, Reali R. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed. 2010 Mar;95(2):F85-9. doi: 10.1136/adc.2009.169219. Epub 2009 Nov 29. PubMed 19948523 ↗
  • Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol. 1999 Sep;19(6 Pt 1):413-8. doi: 10.1038/sj.jp.7200205. PubMed 10685270 ↗
  • Jasani B, Nanavati R, Kabra N, Rajdeo S, Bhandari V. Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med. 2016;29(10):1546-51. doi: 10.3109/14767058.2015.1059809. Epub 2015 Jul 28. PubMed 26135774 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03347136
Lead sponsor
Ministry of Health, Sri Lanka
Responsible party
Dr. Anne kaushalya Shilani Gomez,MBBS,MD (acting consultant neonatologist, Ministry of Health, Sri Lanka) — Principal investigator
First posted
Nov 20, 2017
Start date
Jan 10, 2015
Primary completion
Dec 15, 2015
Completion
Dec 28, 2015
Last update
Nov 20, 2017

Study contacts

ANNE KS GOMEZ, MBBS,MD
principal investigator · Teaching Hospital Mahamodara

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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