Background: The trend today is to minimize the use of mechanical ventilation. Nasal continuous Positive airway pressure (NCPAP) and nasal intermittent Positive pressure ventilation (NIPPV) are 2 non-invasive treatments for respiratory distress syndrome (RDS). There is little study in literature comparing early use of NIPPV with NCPAP as primary modes of respiratory support. The aim of this study is to determine whether NIPPV and NCPAP would have different survival rates and possible complications.Materials and Methods: In this prospective clinical trial study, 120 preterm neonates (gestational age 28-36 weeks) who were admitted due to respiratory distress between January and May 2012 in the neonatal intensive care unit of Afzalipour hospital. Sixty infants were randomized to NCPAP and comparable infants to NIPPV (birth weight 1807.05±52 vs. 1882.50±56 g, gestational age 32.05±2.94 vs. 32.16±2.08 weeks, respectively). Patients were randomly allocated into 2 treatment groups using minimization technique. One group was treated by NCPAP and the second one treated by NIPPV. Survival analysis was applied to estimate and compare survival rates.Results: Infants treated initially with NIPPV needed less endotracheal ventilation than infants treated with NCPAP (13.3% vs. 41.7%, p=0.001). Estimated survival rates at 24 h in NIPPV were 97% versus 82% for NCPAP group. We have seen that the risk of failure for those received NCPAP was nearly 4 times higher than NIPPV group.Conclusion: According to our results, among preterm infants with suspected (RDS), the use of NIPPV reduces the need for intubation and mechanical ventilation in comparison to NCPAP.

Objective: The Cox model is the dominant tool in clinical trials to compare treatment options. This model does not specify any specific form to the hazard function. On the other hand, parametric models allow the researcher to consider an appropriate shape of hazard function for the event of interest. The aim of this article is to compare performance of Cox and parametric models.Methods: We used data collected in a prospective clinical trial that aimed to compare performance of nasal intermittent Positive pressure ventilation (NIPPV) and nasal continuous Positive airway pressure (NCPAP) treatments in terms of survival of newborn infants who had respiratory distress syndrome (RDS). Performance of Cox, exponential, Weibull, and log-logistic models were compared in terms of goodness of fit.Findings: Fitting the Cox model, we have seen that infants who received NCPAP were 4.23 (Hazard Ratio= 4.23, 95% Confidence Interval: 1.87-9.59) times more likely to fail than those received NIPPV (P=0.001). Adequacy of the exponential model was rejected. We have seen a decreasing hazard rate over time, in both treatment groups. This decrease was sharper in NCPAP group. Akiake information criterion corresponded to the log-logistic model and was lower than all other models followed by Weibull model.Conclusion: Our results demonstrate the benefit of parametric survival models over traditional Cox regression model in terms of modeling of shape of hazard function. We saw a decreasing hazard that confirms the flexibility of parametric models in terms of the modeling of hazard rate.

Background Non-invasive ventilation is increased used in preterm infants. We aimed to compare the effectiveness of nasal intermittent Positive pressure ventilation (nIPPV) versus nasal continuous Positive airway pressure (nCPAP) in preterm infants with respiratory distress syndrome (RDS) after less invasive surfactant administration (LISA). Materials and Methods In this clinical trial, eighty two preterm infants admitted in neonatal intensive care unit, Sohag University Hospital, Egypt with a gestational age of 28– 34 weeks, mean ± standard deviation birth weight (1259. 44± 377. 22 grams), suffering from RDS but not requiring intubation in the delivery room were included in the study. Forty one received nIPPV as an initial respiratory support (RS). If nIPPV failed, surfactant administration was given with the LISA approach and patients continued on nIPPV. This group was compared with a historical cohort group of 41 infants managed with nCPAP as an initial RS, and if nCPAP failed, the surfactant was given by LISA. Results There was no significant difference between the case and control group regarding the mean ± SD gestational age or birth weight. When nIPPV was used as the primary RS in preterm infants with RDS compared to nCPAP, it had a significantly less nIPPV failure (31. 71% versus 53. 66%, P = 0. 04), had significantly fewer infants who needed invasive ventilation within the first seven days of life (12. 20% versus 34. 14%, P = 0. 03), and the total days of supplemental oxygen was less (9 (3– 18) days versus 12 (6– 34) days, P = 0. 02). Conclusion In infants born at 28– 34 weeks gestation, nIPPV, when used as the primary RS, reduced the need for invasive ventilation and the surfactant requirement within the LISA technique.