A team of Israeli researchers at Rambam Health Care Campus have just completed a first-of-its-kind clinical trial, the findings of which may have major implications in the field of preterm (also known as premature) infant care.
The clinical study was published in the JAMA Pediatrics medical journal as a part of "preterm awareness month," finding that a lesser-used method for providing respiratory assistance to preterm infants may indeed be just as effective as the most widely used method, with the added benefit of being less invasive.
Many preterm infants need various treatments that support body systems that have not yet developed, or have not developed properly, before their premature birth. One of the common treatments for preterm infants is respiratory assistance.
There are currently two prevalent methods for providing respiratory assistance to premature babies in medical use.
The first method, used only in cases severe respiratory distress, involves intubating the infant orally. Its danger lies both in the invasive nature of the cannula (tube) and accompanying equipment, and in the complex process of anesthetizing a premature infant.
The second method in use today provides respiratory assistance through two short binasal prongs that are inserted nasally. While this method is considered less invasive and doesn't require anesthesia, the hard prongs have still been known to cause tissue damage in preterm infants.
A softer version of the prongs, which uses a longer and more narrow cannula, has come into use in recent years, though some doctors are still hesitant to use them, claiming the harder tubes provide better lung support.
"The prevailing opinion among physicians is that the use of thick and rigid tubes allows for better air pressure and respiratory support to preterm infants, compared to the use of narrow tubes," explains Dr. Uri Hochwald, the senior physician at Rambam's preterm ward who lead the study.
"The methods have been tested in the past using various models that have led to these conclusions, but no one has ever tested the issue on patients," Dr. Hochwald elaborated. "In some cases the preterm infants who received the more aggressive assistance were injured by the tubes in their noses, sometimes even significant injuries that took time to recover from, but the idea was to avoid invasive respiration that involved greater risks. So, in a way, these injuries were the lesser of two evils."
The study was led by Dr. Hochwald and Professor Amir Kugelman of Rambam, in cooperation with the Bnai Zion Hospital in Haifa, and looked at 166 preterm infants, all of whom needed non-invasive respiratory assistance.
The babies were split into two groups, one of which received assistance via prongs, the other via softer, longer cannulas, in order to assess whether the softer cannulas were equivalent to the harder ones.
While processing the data, researchers revealed that in the respiratory group which used the more rigid tubes, which is currently the most commonly used method for providing breath support to preterm infants around the world, the success rates of treatment according to the established criteria were 82%.
The second group, which used the softer, narrow tubes, showed a success rate of 86%, according to the same criteria, and with a significantly lower percentage of injury to the noses of the patients.
"The results of the study mean that we have been able to prove, for the first time, that the controversial method is as effective as the prevailing one," says Dr. Hochwald.
"It sounds like something minor, but for caregivers, infants and families, it is a statistic that allows for a significant improvement in preterm care. It is another tool, but it's non-invasive and less harmful than the standard treatments currently used to care for delicate preterm infants who need respiratory assistance," he added.
"To date, because of decisions that were based on model projections, many preterm treatment centers were unwilling to use this method because they thought it was less effective. Now there is proof. Because we are talking about a treatment that most preterm infants will receive at one time or another, this is an important step for everyone," Dr. Hochwald concluded.
Israel's Preterm Infant day on November 24 along with World Prematurity Day, which is observed on November 17 to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. Approximately 15 million babies are born preterm each year, accounting for about one in 10 of all babies born worldwide.