• Andrea L Lampland, Brenda Plumm, Cathy Worwa, Patricia Meyers, and Mark C Mammel.
• Infant Diagnostic & Research Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA Department of Pediatrics-Neonatology, University of Minnesota, Minneapolis, Minnesota, USA.
• Arch. Dis. Child. Fetal Neonatal Ed. 2015 Jan 1;100(1):F31-4.

AimWe hypothesised that short-term application of bi-level nasal continuous positive airway pressure CPAP (SiPAP) compared with conventional nasal CPAP (nCPAP) at the same mean airway pressure in infants with persistent oxygen need recovering from respiratory distress syndrome would improve CO2 removal with no change in oxygen requirement.DesignNon-blinded, randomised, observational four-period crossover study.Setting/PopulationLevel III NICU; low-birthweight infants requiring CPAP and oxygen while recovering from respiratory distress syndrome.MethodsInfants requiring nasal CPAP for >24 h prior to study enrolment, and fraction of inspired oxygen requirement (FiO2) of 0.25-0.5, were randomised to either nCPAP or SiPAP. A crossover design with four 1 h treatment periods was used such that each infant received both treatments twice. Oxygen saturations (SaO2), transcutaneous CO2 (tcCO2) and vital signs were monitored continuously. Polysomnographic recordings were analysed for apnoea, bradycardia and oxygen desaturation.ResultsTwenty low-birthweight infants receiving 0.3±0.04% supplemental oxygen on CPAP of 6 cm H2O were studied at an average of 33 days of age (±23 days, SD). There were no differences in tcCO2 or other physiological parameters except mean blood pressure, which was lower during nCPAP (52.3±8.3 vs 54.4±9.1 mm Hg; ±SD; p<0.01). No differences in short or prolonged apnoea, bradycardia or significant desaturation events were observed.ConclusionsAt similar mean airway pressures, SiPAP does not improve CO2 removal, oxygenation or other studied physiological parameters with the exception of mean blood pressure, which was not clinically significant.Trial Registration NumberNCT01053455.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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