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Original Investigation
Caring for the Critically Ill Patient
December 4, 2017

Effect of Nasal Continuous Positive Airway Pressure on Infants With Meconium Aspiration SyndromeA Randomized Clinical Trial

Author Affiliations
  • 1Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
  • 2Vijay Marie Hospital, Hyderabad, Telangana, India
  • 3Princess Durru Shehvar Children’s and General Hospital, Hyderabad, Telangana, India
JAMA Pediatr. Published online December 4, 2017. doi:10.1001/jamapediatrics.2017.3873
Key Points

Question  Can the use of nasal continuous positive airway pressure early in the course of meconium aspiration syndrome reduce the subsequent need for mechanical ventilation in newborns?

Findings  In this randomized clinical trial that included 135 infants with moderate or severe meconium aspiration syndrome, 2 infants (3%) supported with nasal continuous positive airway pressure required subsequent mechanical ventilation in the first 7 days of life vs 17 infants (25%) who were supported with hood oxygen, a significant difference.

Meaning  There is a possibility for reduction in the need for subsequent mechanical ventilation if infants with moderate or severe meconium aspiration syndrome are initially supported with nasal continuous positive airway pressure in place of hood oxygen.

Abstract

Importance  Nasal continuous positive airway pressure (NCPAP) as a primary respiratory therapy in meconium aspiration syndrome (MAS) has not been studied extensively. Nasal continuous positive airway pressure, when applied in newborns with MAS, may resolve atelectasis by sufficiently expanding partially obstructed small airways and stabilizing the collapsing terminal airways to enhance oxygen exchange.

Objective  To compare NCPAP vs standard care in neonates with moderate to severe respiratory failure due to MAS in reducing the need for invasive ventilation.

Design, Settings, and Participants  This multicenter open-label, parallel-group (1:1 ratio) randomized clinical trial was conducted from August 5, 2014, to May 26, 2016. Data were collected from 3 tertiary care neonatal intensive care units. All infants admitted with respiratory distress, defined as Downe score greater than 4 and peripheral capillary oxygen saturation less than 90%, were assessed for study eligibility if the chest radiograph was suggestive of MAS and they met the other inclusion criteria: gestation longer than 35 weeks, a birth weight greater than 2000 g, and born through meconium-stained amniotic fluid.

Interventions  Infants were randomly assigned to either NCPAP or standard care (5-10 L/min hood oxygen).

Main Outcomes and Measures  The primary outcome was the need for mechanical ventilation in the first 7 days of life.

Results  After excluding 14 infants, 67 infants were randomized to bubble NCPAP and 68 infants to standard care. Baseline characteristics were similar between the 2 groups. Infants randomized to the bubble NCPAP group needed mechanical ventilation less frequently in the first 7 days of life compared with standard care (2 [3.0%] vs 17 [25.0%]); odds ratio, 0.09; 95% CI, 0.02-0.43; P = .002). The need for surfactant (3 [4.5%] vs 11 [16.2%]; odds ratio, 0.24; 95% CI, 0.05-0.87) and culture-positive sepsis (4 [6.0%] vs 13 [19.0%]; odds ratio, 0.28; 95% CI, 0.09-0.93) were higher in the standard care group. There was an increased duration of oxygen therapy (median [interquartile range], 45.5 [28.0-78.3] vs 26 [20.0-48.0] hours; P = .001) in the standard care group. In the NCPAP group vs standard care group, incidence of persistent pulmonary hypertension (9 [13%] vs 19 [28%]; odds ratio, 0.42; 95% CI, 0.17-1.01) and duration of hospital stay (median [interquartile range], 5.0 [4.0-8.8] vs 4.0 [4.0-6.0] days; P = .14) were similar.

Conclusions and Relevance  Bubble NCPAP in comparison with standard care for infants with MAS reduces the need for mechanical ventilation in the first 7 days of life.

Trial Registration  Clinical Trial Registry, India Identifier: CTRI/2015/03/005631

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