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ABSTRACT.Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).Methods. A prospective randomized study was conducted, in which infants <30 weeks' gestation were randomized to the SURF-NCPAP group or the SURF-MV group.Results. At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit. Pediatrics 2004;113:e560 -e563. URL: http: //www.pediatrics.org/cgi/content/full/113/6/e560; continuous positive airway pressure, mechanical ventilation, surfactant, respiratory distress syndrome, infant.ABBREVIATIONS. a/APo 2 , arterial/alveolar oxygen tension ratio; iRDS, infant respiratory distress syndrome; MV, mechanical ventilation; NCPAP, nasal continuous positive airway pressure; SURF-MV, mechanical ventilation after surfactant treatment; SURF-NCPAP, nasal continuous positive airway pressure after surfactant treatment; Fio 2 , fraction of inspired oxygen; IVH, intraventricular hemorrhage; BPD, bronchopulmonary dysplasia; ROP, retinopathy of prematurity; PDA, patent ductus arteriosus.T he cornerstones of treatment of infant respiratory distress syndrome (iRDS) are artificial respiratory support and surfactant treatment. Among respiratory support techniques, nasal continuous positive airway pressure (NCPAP) 1 and mechanical ventilation (MV) 2 are known for their effectiveness in reducing the mortality and morbidity rates associated with iRDS. Moreover, early application of NCPAP 1 and early treatment with surfactant 3 are effective in decreasing the need for MV, with its related adverse effects. Unfortunately, these results are not always taken into account in neonatal intensive care units, and MV is often initiated after endotracheal intubation for surfactant administration, without consideration of the fact that many infants who are able to breathe spontaneously could be supported with NCPAP only. [4][5][6][7] The present study was planned to test the hypothesis that preterm infants (Ͻ30 weeks' gestation) with iRDS who were treated with N...

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There is still a need for programs that support and encourage breast feeding, focusing particularly on mothers with a low level of education who give birth to a low-weight infant, primiparous mothers, and smokers.

Inhaled nitric oxide decreases the incidence of bronchopulmonary dysplasia and death in preterm infants with severe respiratory distress syndrome. Birth weight may influence the effectiveness of inhaled nitric oxide therapy in promoting oxygenation improvement in preterm infants.