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Title: The use of continuous negative extrathoracic pressure in the neonatal respiratory distress syndrome
Author: Raine, Joseph
ISNI:       0000 0004 2682 1624
Awarding Body: The University of Manchester
Current Institution: University of Manchester
Date of Award: 1995
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Our aim was to re-evaluate the role of CNEP in RDS using a modified CNEP chamber. The new CNEP system comprised a thin (0.25 mm) rubber neck seal, facilities for routine and emergency patient access and an air controlled incubator heater. The protocol of the randomised controlled trial of CNEP in RDS is presented. There were 122 matched pairs in the trial. The trial showed that CNEP leads to a fall in the mean duration of oxygen therapy (-15.3, 95% CI -30.4 to -0.2 days), and to a decrease in the incidence of BPD (-12, 95% CI -23 to -1%). Patients in the CNEP limb also had a substantially decreased incidence of PDA (-10, 95% CI -17 to -2%). The complications of CNEP treatment included neck trauma (1.6%), upper airway obstruction (0.8%) and hypothermia following transfer to the CNEP chamber (mean temperature at 12 hours of age 35.7 in CNEP limb, 36.8°C in standard limb, p<0.01). The cardio-respiratory effects of CNEP and standard treatment in spontaneously breathing and in ventilated neonates with RDS, during the first 72 hours of life were compared in a sub-set of the trial. Spontaneously breathing infants undergoing CNEP and oxygen therapy (n=6) required a lower FiO₂ (0.32 compared to 0.54, p<0.01) compared to infants receiving oxygen therapy ± continuous positive airways pressure (n=6). Ventilated patients in the CNEP limb (n=16) required lower mean airway pressures (7.1 compared to 9.9 cmH₂O, p<0.05) and peak inspiratory pressures (15.4 compared to 19.1 cmH₂O, p<0.05) than those in the standard limb (n=21). The trial has demonstrated beneficial effects of CNEP on respiratory function and in particular a decrease in the incidence of BPD. However, further research, particularly into the long term neuro-developmental and respiratory effects of CNEP, is required further to establish the role of CNEP in RDS.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available