Critically appraised paper: Nasal continuous positive airway pressure for infants with meconium aspiration syndrome reduces the need for mechanical ventilation in the first seven days of life [commentary]

摘要

Question: Does nasal continuous positive airway pressure reduce the need for mechanical ventilation in the first 7 days of life in neonates with respiratory failure due to meconium aspiration syndrome? Design: Randomised controlled trial with concealed allocation and blinded outcome assessment. Setting: Three tertiary care neonatal intensive care units in India. Participants: Inclusion criteria were in- fants: born with meconium staining of amniotic fluid; > 35 weeks’ gestation and birth weight > 2000 g; admitted to the neonatal inten- sive care unit in the first 24 hours of birth due to respiratory distress; and chest radiograph suggestive of meconium aspiration syndrome. Exclusion criteria were: intubation at admission; severe asphyxia (5- minute Apgar score < 3 and cord potential of hydrogen level < 7); pneumothorax and/or air leak (visible on the admission chest radio- graph); and major malformations. Randomisation of 135 participants allocated 67 to an intervention group and 68 to a control group. In- terventions: The intervention group was started on a bubble nasal continuous positive airway pressure generator (Fisher and Paykel Care) using short binasal prongs. The starting pressure was 5 cmH20. Both the pressure and the fraction of inspired oxygen were adjusted to maintain target oxygen saturation between 90% and 95%.