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Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity in the management of respiratory distress in preterm neonates. However, it is not known whether it takes precedence over the gold standard nasal continuous positive airway pressure (NCPAP) in this age group as a primary mode of non-invasive ventilation (NIV). There is limited evidence addressing this issue in the literature. Therefore, this study aimed to focus on the effect of HHHFNC on preterm neonates with respiratory distress, compared to NCPAP as a primary mode of respiratory support. Methods: A prospective observational study conducted in tertiary level III NICU. The preterm neonates 28-36 weeks with respiratory distress syndrome (onset of distress within ≤4 hours of life with FiO2 ≥0.25 with compatible chest radiograph) were managed with either HHHFNC or nCPAP The need for invasive ventilation within 72 hours of initiation of non-invasive respiratory support was studied. FiO2 and Downe’s scores were recorded every 4th hour for the first 48 hours. Results: In total, 84 neonates were enrolled in this study. Treatment failure for HHHFNC group was 34.4%, whereas it was 32.2% (P=0.34) for NCPAP group which indicated no significant differences. In the late preterm strata, NCPAP group obtained longer duration for NIV (Median: 64 vs 43 hours, respectively; PConclusion: Early HHHFNC obtained similar results, compared to NCPAP as a primary mode of NIV for a preterm population with respiratory distress, and it may not be superior to NCPAP.

Background: This study was targeted toward comparing volume-guaranteed (VG) ventilation with conventional pressure-controlled (PC) ventilation in preterm infants with respiratory distress syndrome (RDS) in terms of the facilitation of weaning and extubation and occurrence of complications, such as pneumothorax, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC). Methods: This single-center randomized controlled trial was conducted on neonates who were mechanically ventilated in the Neonatal Intensive Care Unit of Kasturba Hospital Manipal Udupi, Karnataka, India. Infants with the gestational age (GA) of 27-34 weeks with RDS requiring mechanical ventilation in the first week of life were randomized to receive either SIMV-PC or SIMV-VG ventilation. Infants were stratified into two GA groups of 27-30 and 31-34 weeks. Sealed opaque envelope was used to randomize the infants into two treatment modalities. Sample size was calculated as 120 and 60 in each treatment group. Results: A total of 115 neonates were enrolled. The mean GA and birth weight of the treatment groups were 31±2.3 weeks and 1230±374 g, respectively, and 70% of them received antenatal steroids. As the primary outcome variable, the total duration of ventilation was 8 h (range: 3-17) (median and IQR) in the SIMV-PC group and 6 h (range: 3-13) in the SIMV-VG group (P=0.366). Stratified analysis of neonates with the GA of > 31-34 weeks showed a significant difference between the VG and PC ventilation groups regarding the duration of ventilation. Conclusion: There was a decrease in the duration of ventilation in VG ventilation, compared to that in PC ventilation at a higher GA. The leak was the major issue with VG ventilation in the lower GA group.

Background: Early nasal continuous positive airway pressure (NCPAP) has emerged as a primary modality of respiratory support for preterm infants withrespiratory distress syndrome (RDS). However, 30%-40% of these newborns need subsequent mechanical ventilation. Nasal intermittent positive pressure ventilation (NIPPV) is a promising alternative to NCPAP, especially in post-extubation settings, apnea of prematurity, or NCPAP failure as the primary mode of respiratory support in RDS. Application of these two methods in neonates with RDS needs further studies. Methods: This open-label randomized clinical trial (RCT) was stratified by gestational age (i.e., 28-32 and 33-36 weeks). The sample included 78 infants divided into the two groups of 37 NIPPV and 41 CPAP. We compared the effect of ventilator delivered asynchronous NIPPV with NCPAP in reducing the need for invasive ventilation within 48 h of non-invasive support in infants of 28-36 weeks with RDS [onset of distress within ≤ 6 h of life with a fraction of inspired oxygen (FiO2) ≥ 0.25 compatible with chest radiograph]. The FiO2 > 0.3 and/or Downes score ≥ 4 were the indications for surfactant therapy administered by endotracheal tube. The infants were extubated and returned to their initial assigned mode of support within 60 min. The primary outcome was considered as failure of the allocated mode within 48 h. Results: According to our findings, the two groups showed no significant difference in terms of failure rates with 5 (13.5%) and 6 (15%) failed NIPPV and NCPAP cases (P=0.8). There was a trend toward less surfactant therapy in NIPPV [12 (32.4%) vs. 22 (53.7%), P=0.06], and lower Downes score in the first 12 h. The hazard ratio (HR; adjusted for gestation, surfactant therapy, and birth weight) for failure in NIPPV was similar to that of NCPAP (HR=1.03) at 95% confidence interval. No difference in air leaks or abdominal distension was noted between the two groups. Conclusion: Early NIPPV may not have a benefit, compared to NCPAP as a primary mode of respiratory support for infants with RDS.

Background: Carbon dioxide (CO2) is a by-product of cellular metabolism, which could be considered as a reflection of metabolism, circulation, and ventilation. Arterial blood gas analysis (ABG) is the gold standard of monitoring for CO2. However, is an expensive method leading to blood loss and iatrogenic anemia. In addition, each sample is only a snapshot view of the sampling moment. End-tidal CO2 (ETCO2) measurement gives a non-invasive and continuous monitoring of exhaled CO2. Therefore, this study aimed to validate the non-invasive CO2 measurement performed by nasal cannula and evaluate the correlation with partial pressure of arterial CO2 (PaCO2 ) in neonates. Methods: This single-center observational study was conducted in the Neonatal Intensive Care Unit (NICU), Kasturba Hospital, Manipal, India. PaCO2 was reported on routine ABG within a 15-minute interval of ABG sampling. Moreover, partial pressure of end-tidal carbon dioxide (PetCO2) was noted at continuous 30-sec intervals (i.e., 30, 60, 90, ..., 180) up to 3 minutes. The values of PaCO2 and PetCO2 were found to be correlated with Pearson correlation and were shown by scattered plot. Regression analysis was used to get the prediction equation and the variance. Results: A total of 70 samples were taken in the initial phase to study the correlation between PaCO2 and measured PetCO2. Pearson correlation showed a moderate positive correlation (r= 0.589) between PetCO2 and measured PaCO2. Regression analysis demonstrated a variance of 33.8% between the measured PetCO2 and PaCO2, which was statistically significant (P