الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 88 |  |  |
| | | from | 88 | | |
Abstract
Respiratory distress is a leading cause of morbidity and mortality in preterms and remains a major problem for clinicians and researchers in neonatology. It accounts for nearly half of all neonatal deaths. Respiratory distress syndrome (due to inadequate pulmonary surfactant) is the most prevalent respiratory disorder among preterm infants.
Surfactant therapy (as line of management for RDS) is one of the few treatments that have dramatically changed clinical practice in neonatology. Since its introduction, it has become a standard of care for many preterm infants with RDS, both in NIV and MV. Both the administration of exogenous surfactant and the use of different modalities of ventilatory support can influence short- and long-term outcomes of preterm infants with respiratory distress.
The aim of work was to compare between NCPAP and Invasive mechanical ventilation after surfactant administration in preterm neonates with respiratory distress syndrome.
The current study is a prospective interventional comparative study that was conducted in the NICU of AUCH over 6 months. It included 82 preterm neonates whose gestational age ranged from 28-34 weeks, and diagnosed with RDS secondary to primary lung disease.
The studied neonates were randomly divided into 2 groups using sealed envelope technique. The first group (group I) 41 preterm neonates were assigned to exogenous surfactant administration followed by NCPAP while the second group (group II) 41 preterm neonates were managed with Mechanical ventilation by (SLE 4000 TTV plus) following exogenous surfactant administration.
The 2 groups enrolled in this study were evaluated for the outcome of both techniques using the following parameters: chest radiographs, ABG, A/a oxygen gradient, PaO2/FIO2 ratio, echocardiography and cranial U/S.
Our results could be summarized into:
Regarding response of cases in group I to NCPAP after surfactant administration, there were 73.2% of cases succeeded and the need for MV was eliminated. While 26.8% of cases failed and need MV because of different causes as hypercapnia, apnea and increased requirement of FIO2 to maintain O2 saturation with percentages (18.2% , 9.1% ,45.5%) respectively.
The success rate of group I was comparable to response of cases in group II to MV after surfactant administration, there were 78% of cases succeeded and weaned (extubated) within 72 hours after birth .While 22% of cases failed to be weaned and MV was needed.
Regarding incidence of complications, except for pneumothorax and IVH that were significantly more frequent among neonates in group II than in group I
(41.5% versus 17.1% for IVH, and 36.6% versus 7.3% for pneumothorax), there were no significant statistical differences between both groups regarding other adverse events including: PDA, BPD, late onset sepsis, VAP, meningitis and reventilation (after period of successful weaning from either NCPAP or MV).
Moreover, there were no significant statistical differences between both groups regarding days of ventilation (either NCPAP or MV), days of oxygen dependence (including duration of ventilation and duration after weaning), days of hospital stay and mortality rate.
An approach that combines the benefits of surfactant administration and the benefits of early CPAP but without the drawbacks associated with mechanical ventilation has great intellectual appeal.