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Indian Pediatr 2012;49: 928-929 |
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Reply
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SN Singh
Associate Professor, Department of Pediatrics,
Chhatarpati Shahu Maharaj Medical University,
Lucknow 226 003, Uttar Pradesh, India.
Email:
[email protected]
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We thank the authors for their
interest in our study [1]; 296 infants assessed for
eligibility were cases having respiratory distress syndrome
and requiring ventilation; of these, 150 infants were
randomized. The remaining 146 infants could not be included
because either they were excluded as per exclusion criteria,
or the designated ventilator was not available, and thus, it
does not reflect CPAP failure rate. The diagnosis of hyaline
membrane disease was made as per working definition of NNPD
of India, which includes clinical parameters, and chest
radiology or negative gastric aspirate shake test.
Oxygen index (OI) was the primary outcome
and it was measured at 1, 6 and 24 hours. Since significant
drop-out was expected and we intended to look for
longitudinal trend in OI over time on first day of
ventilation, it was decided a priori to conduct
analysis only on those infants who complete initial 24 hrs
of ventilation. Moreover, the proportion of subjects who
could not complete initial 24 hrs of ventilation after
randomization were quite similar in both the groups (HFOV:
25.8%; SIMV: 27.3%).
As per our unit policy we administer
surfactant to preterms with gestational maturity < 34 wks
having respiratory distress due to HMD at earliest possible
hours; however, it is used in only those who can afford it.
We use Curosurf (porcine minced) for infants weighing <1000
g and Survanta (bovine minced) for those >1000 g. None of
our patients in either group had received multiple doses of
surfactant. Detailed analysis of patients receiving
surfactant was not a stated objective; however, the major
baseline characteristics were similar in both the groups. It
was aimed to keep the tidal volumes lower by using lower PIP
and optimal PEEP to maximally recruit lungs in synchronized
intermittent mandatory ventilation (SIMV) group; however,
tidal volume was not measured.
References
1. Singh SN, Malik GK, Prashanth GP, Singh A, Kumar M.
High frequency oscillatory ventilation versus
synchronized intermittent mandatory ventilation in preterm
neonates with hyaline membrane disease: A randomized
controlled trial. Indian Pediatr. 2012;49:405-8.
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