Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital

Abstract

Background: Respiratory distress syndrome remains an important cause of 22 neonatal mortality and morbidity worldwide. Early initiation of continuous 23 positive airway pressure is a standard of care for preterm infants with 24 respiratory distress syndrome. Positive end-expiratory pressure reduces the ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS2 25 need for invasive ventilation and prevents chronic lung disease. However, 26 the optimum positive end expiratory pressure level to effectively treat 27 respiratory distress syndrome in preterm infants remains unknown. 28 Objective: To determine the optimal initial positive end expiratory pressure 29 level in management of preterm infants with respiratory distress syndrome. 30 Methods: This prospective descriptive study was conducted from July 2023 31 to January 2024 in the newborn unit of Moi Teaching and Referral Hospital. 32 A total of 204 preterm infants (28-34 weeks gestational age) with 33 respiratory distress syndrome who required Continuous Positive Airway 34 Pressure treatment were recruited. Data on the maternal and neonatal 35 characteristics, low and high positive end expiratory pressure levels, and 36 outcomes at 72 hours were collected and analysed. Descriptive statistics 37 were used for continuous variables, and frequencies were used for 38 categorical data. A p value less than 0.05 was considered statistically 39 significant at the 95% confidence interval. Receiver operating characteristic 40 curves were used to determine the optimal positive end expiratory pressure 41 level. 42 Results: A total of 45 and 159 preterm infants were started on low and high 43 positive end expiratory pressure levels, respectively. Among 159 (77.9%) of 44 the preterm infants started on high positive end expiratory pressure levels, 45 majority (135, 66.2%) were initiated at a positive end expiratory pressure 46 level of 6 cmH2O. The Area under the curve for low positive end expiratory ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS3 47 pressure levels was 0.5757 and the one for high positive end expiratory 48 pressure levels was 0.5405. DeLong's test for two ROC curves D = 0.82979, 49 df = 120.8, p value = 0.4083. The area under the curve of both low and high 50 positive end expiratory pressure levels were close and not significantly 51 different (p=0.4083). 52 Conclusion: In this study, low positive end expiratory pressure was 53 associated with low failure rate and complications. However low and high 54 positive end expiratory pressure levels were not significantly different to 55 determine the optimal initial PEEP. Further research are needed to 56 determine optimal PEEP for continuous positive airway pressure initiation 57 in preterm infants with respiratory distress syndrome