الفهرس 
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Abstract
R
espiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short bi-nasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. every effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma.
We conducted our study to investigate the effectiveness of nasal high frequency oscillatory ventilation (nHFOV) in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome.
This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout a period of six months.
In the current study, there was a significant decrease in FiO2 need in nHFOV group vs. nCPAP group (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), and significant improvement in degree of RDS measured by Silverman score.
However, there was no statistically significant difference between both study groups regarding RD grade by total Silverman score after 6 hours of management.
Regarding of ABG parameters after 6 hours in both groups, there was a significantly higher PH in nHFOV group, significant higher change in PH between initial and follow up after 6 hours of management in nHFOV group, significant decrease of PaCO2 in nHFOV group, significant higher change in PaCO2 between initial and follow up after 6 hours in nHFOV group, significant lower HCO3 in nHFOV group, but a significant higher change in HCO3 between initial and follow up after 6 hours in nHFOV group and no significant difference in BE after 6 hours between both groups, but a significantly higher change in BE between initial and follow up after 6 hours in nHFOV group.
There was no statistically significant difference between both study groups regarding duration of respiratory support either on nHFOV or nCPAP support. Also, there was no statistically significant difference between the two groups regarding the need of IMV.
There was significant decrease of total hospital stay in nHFOV group.
There was a significant increase in the use 1st line antibiotic in nHFOV group, and a higher need to shift to second and third line antibiotics in nCPAP group.
nHFOV is better in elimination of CO2 and the decrease need of FiO2 and better in decrease of total hospital stay.
There was no statistically significant difference between the development of complications.
Using nHFOV is superior to nCPAP as primary mode in treatment of RDS as it has significant elimination of CO2 with a decrease need of FiO2 and a decrease in total hospital stay.