Mohammad Kazem Sabzehei - Hamadan University of Medical Sciences
Behnaz Basiri - Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
Maryam Shokouhi - hamedan university of medical science
Mojdeh Afkhami Goli - Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran.
Fatemeh Eghbalian - Pediatric department, Hamadan University of Medical Sciences , Hamadan , Iran
Abbas Moradi - Department of community medicine, Hamadan University of Medical Science , Hamadan, Iran.

Background: There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA).Methods: The present clinical trial included ۹۵ preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October ۲۰۱۹ to September ۲۰۲۰, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=۴۸) or NCPAP (n=۴۷) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within ۷۲ hours after birth.Results: The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within ۷۲ hours after birth  compared to the control group (۸.۳% vs. ۲۷.۷%, P=۰.۰۱۴); however, the groups were not significantly different regarding the need for the second dose of surfactant (۶۶% vs. ۵۶.۲%, P=۰.۳۳۲), the mean respiratory support duration (۶.۸۹±۳.۲۰ vs. ۶.۷۰±۳.۷۱ days, P=۰.۲۹۵), the mean hospital stay (۱۹.۵۲±۱۲.۳۶۴ vs. ۱۷.۴۰±۹.۵۷ days, P=۰.۵۹۱), development of bronchopulmonary dysplasia (۴.۲% vs. ۸.۵%, P=۰.۴۳۵), and mortality (۶.۲۵% vs. ۱۲.۸%, P=۰.۳۱۷).Conclusion: Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within ۷۲ hours after birth in neonates undergoing LISA

RDS, preterm infants, NIPPV, NCPAP, LISA