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INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması

Year 2022, Volume: 1 Issue: 2, 77 - 83, 27.09.2022

Abstract

Amaç: Respiratuar distres sendromu (RDS), preterm bebeklerde surfaktan eksikliği ve akciğer immaturitesine bağlı gelişen solunum yetmezliğidir. Çalışmamızda; INSURE yöntemiyle surfaktan uygulanan pretermlerin iki farklı non-invaziv ventilasyon yöntemi ile izlemi sırasında kısa ve uzun dönem etkilerin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Çalışmamız Ocak 2016-Aralık 2016 tarihleri arasında yapılan tek merkezli, prospektif, randomize kontrollü bir çalışmadır. İzmir Dr. Behçet Uz Çocuk Hastanesi yenidoğan yoğun bakım ünitesine RDS tanısıyla yatırılıp surfaktan verilen ve gebelik haftası <32 hafta ve/veya doğum ağırlığı 1500 gramın altında olan pretermler çalışmaya dahil edildi. Kapalı zarf usulü ile ventilasyon tipi senkronize nazal aralıklı pozitif basınçlı ventilasyon (SNIPPV) ve nazal sürekli pozitif hava yolu basıncı (NCPAP) olarak randomize edildi. Birincil sonuçlar olarak reentübasyon, apne sıklığı, ek surfaktan gereksinimi, pnömotoraks/ atelektazi gelişimi, gastrik rezidü varlığı kaydedildi. İkincil sonuçları hastaların kapiller kan gazlarındaki parsiyel karbondioksit basıncı (pCO2), oksijen ihtiyacı ve komorbiditeleri oluşturdu.
Bulgular: Çalışmaya SNIPPV grubunda 15, NCPAP grubunda 20 bebek olmak üzere toplam 35 bebek katıldı. Reentübasyon oranı NCPAP grubunda %15, SNIPPV grubunda ise %13.3 iken, gastrik rezidü NCPAP grubunda %35 SNIPPV grubunda %26.6 idi (sırasıyla p>0.05 ve p>0.05). Karşılaştırılan diğer birincil sonuçlar arasında da anlamlı fark bulunamadı (p>0.05). Her iki grupta gelişen komorbiditeler arasında istatistiksel anlamlı fark bulunmadı (p>0.05). SNIPPV grubunda 48. saatte pCO2 düzeyi NCPAP grubundakilerden istatistiksel farka yol açacak şekilde düşüktü (p<0.05). Oksijen gereksinimi SNIPPV grubunda 48. saatte daha düşüktü ve bu fark anlamlıydı (p>0.05) Her iki grupta da mortalite gözlenmedi.
Sonuç:
Prematüre bebeklerde INSURE yöntemiyle sürfaktan verilmesi sonrası SNIPPV grubunda NCPAP grubuna göre reentübasyon sıklığı ve 48. saatte oksijen gereksiniminin daha az olduğu, SNIPPV’nin beslenme intoleransı üzerine NCPAP’dan farklı bir negatif etkisi olmadığı gösterilmiştir.

References

  • 1.Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology 2019;115(4):432-450. doi: 10.1159/000499361.
  • 2.Gomella TL, Eyal FG, Bany-Mohammed F. Gomella Neonatoloji. Yenidoğan Hastalıklarına Genel Bakış. Respiratuvar Distres Sendromu, 6:117:1043,1044.1045.
  • 3. Özkan H, Erdeve Ö, Kanmaz Kutman HG. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment Turk Pediatri Ars 2018; 53(Suppl 1): S45-S54.
  • 4. Azzabi O, Selmi I, Bellali H, Siala N, Dridi Y, Fetni I, et al. Intubation-Surfactant-Extubation Strategy in a Medical Resource-limited Department: A Prospective Study. J Trop Pediatr 2016 Apr;62(2):169-70. doi: 10.1093/tropej/fmv074.
  • 5. Jena SR, Bains HS, Pandita A, Verma A, Gupta V, Kallem VR, et al. Surfactant therapy in premature babies: SurE or InSurE. Pediatr Pulmonol 2019 Nov;54(11):1747-1752. doi: 10.1002/ppul.24479.
  • 6. Behnke J, Lemyre B, Czernik C, Zimmer KP, Ehrhardt H, Waitz M. Non-Invasive Ventilation in Neonatology. Dtsch Arztebl Int 2019 Mar 8;116(11):177-183. doi: 10.3238/arztebl.2019.0177.
  • 7. Zhao YH, Liu YJ, Zhao XL, Chen WC, Zhou YC. Application of two noninvasive scores in predicting the risk of respiratory failure in full-term neonates: a comparative analysis. Zhongguo Dang Dai Er Ke Za Zhi 2022 Apr 15;24(4):423-427. doi: 10.7499/j.issn.1008-8830.2110023.
  • 8. Akisu M, Kumral A, Canpolat FE. Turkish Neonatal Society Guideline on neonatal encephalopathy. Turk Pediatri Ars 2018 Dec 25;53(Suppl 1):S32-S44. doi: 10.5152/TurkPediatriArs.2018.01805.
  • 9. Goldstein B, Giroir B, Randolph A, et al. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005 Jan;6(1):2-8. doi: 10.1097/01.PCC.0000149131.72248.E6.
  • 10. Oygür N , Önal EE, Zenciroğlu A. Turkish Neonatal Society national guideline for the delivery room management. Turk Pediatri Ars 2018; 53(Suppl 1): S3-S17
  • 11. Goldsmith J, P Karotkin E, Keszler M, Assisted Ventilation of the Neonate: Evidence-Based Approach to Newborn Respiratory Care Sixyh Edition, Philadelphia, United States, Elsevier- Health Science Division, Oxygen therapy and respiratory support,2017; 15:146-148.
  • 12. Ribeiro DFC, Barros FC, Fernandes BL, Nakato AM, Nohama P . Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial. . 2020 Jul 2;6(7):e04366. doi: 10.1016/j.heliyon.2020.e04366.
  • 13. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev 2013 Oct;89 Suppl 2:S13-20. doi: 10.1016/j.earlhumdev.2013.07.013.
  • 14. Koç E, Baş AY, Özdek Ş, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars 2018; 53(Suppl 1): S151-S160.
  • 15. Özek E, Kersin SG. Intraventricular hemorrhage in preterm babies. Turk Pediatri Ars 2020; 55(3): 215–21.
  • 16. Köksal N, Aygün C, Uras N. Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants. Turk Pediatri Ars 2018; 53(Suppl 1): S76-S87
  • 17. Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatr Rev 2017 Dec;38(12):552-559. doi: 10.1542/pir.2017-0002.
  • 18. Arsan S, Korkmaz A, Oğuz S. Turkish Neonatal Society guideline on prevention and management of bronchopulmonary. Turk Pediatri Ars 2018; 53(Suppl 1): S138-S150.
  • 19. Blennow M, Bohlin K. Surfactant and noninvasive ventilation. Neonatology 2015;107(4):330-6. doi: 10.1159/000381122.
  • 20. Dunn, MS, Kaempf J, De Klerk A, De Klerk R, Reilly M, Howard D, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011 Nov;128(5):e1069-76. doi: 10.1542/peds.2010-3848.
  • 21. Wiingreen R, Greisen G, Ebbesen F, Petersen JP, Zachariassen G, Henriksen TB, et al. Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013. Neonatology 2017;111(4):331-336. doi: 10.1159/000451021.
  • 22. Hermansen CL, Mahajan A. Newborn Respiratory Distress. Am Fam Physician 2015 Dec 1;92(11):994-1002.
  • 23. Verder H , Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrøm K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group. N Engl J Med 1994 Oct 20;331(16):1051-5. doi: 10.1056/NEJM199410203311603.
  • 24. Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics 1999 Feb;103(2):E24. doi: 10.1542/peds.103.2.e24.
  • 25. Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 2007 Oct 17;2007(4):CD003063. doi: 10.1002/14651858.CD003063.pub3.
  • 26. Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017 Jan;102(1):F17-F23. doi: 10.1136/archdischild-2015-310299.
  • 27. Roberts CT, Davis PG, Owen LS. Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013? Neonatology 2013;104(3):203-9. doi: 10.1159/000353448.
  • 28.Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2017 Feb 1;2(2):CD003212. doi: 10.1002/14651858.CD003212.pub3.
  • 29. Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 2013 May;162(5):949-54.e1. doi: 10.1016/j.jpeds.2012.11.016.
  • 30. Öktem A, Yiğit Ş, Çelik HT, Yurdakök M. Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants. Turk J Pediatr 2021;63(1):23-30. doi: 10.24953/turkjped.2021.01.003.

Comparison of Efficiency and Complications of Two Different Non-invasive Ventilation Methods of Preterm Babies Treated with INSURE

Year 2022, Volume: 1 Issue: 2, 77 - 83, 27.09.2022

Abstract

Aim: Respiratory distress syndrome (RDS) is a respiratory failure due to surfactant deficiency and lung immaturity in preterm infants. In our study; we aimed to compare the short-term and long-term effects during the follow-up of preterms who were administered surfactant with the INSURE method with two different non-invasive ventilation methods.
Materials and methods: Our study is a single-center, prospective, randomized controlled study conducted between January 2016 and December 2016. Preterms with a gestational age of <32 weeks and/or a birth weight of less than 1500 grams, who were admitted to the neonatal intensive care unit of Dr Behçet Uz Children's Hospital with the diagnosis of RDS and given surfactant, were included in the study. The ventilation type was randomized to synchronized nasal intermittent positive pressure ventilation (SNIPPV) and nasal continuous positive airway pressure (NCPAP) using the sealed envelope method. Reintubation, apnea, additional surfactant requirement, development of pneumothorax/atelectasis, gastric residue were recorded as primary outcomes. The secondary results were partial pressure of carbondioxide (pCO2) in the capillary blood gases of the patients, oxygen requirement and comorbidities.
Results: A total of 35 infants, 15 in the SNIPPV group and 20 in the NCPAP group, participated in the study. The re-intubation rate was 15% in the NCPAP group and 13.3% in the SNIPPV group, while the gastric residual was 35% in the NCPAP group and 26.6% in SNIPPV group (p>0.05 and p>0.05; respectively). No significant difference was found between the other primary results compared (p>0.05). There was no statistically significant difference between comorbidities in both groups (p>0.05). The pCO2 level at 48th hour in the SNIPPV group was lower than that in the NCPAP group, leading to a statistically significant difference (p<0.05). Oxygen requirement was lower in the SNIPPV group at 48th hour, and this difference was significant (p>0.05). No mortality was observed in either group.
Conclusion: It has been shown that after the administration of surfactant with the INSURE method in premature infants, the frequency of reintubation and oxygen requirement at 48 hours were lower in the SNIPPV group compared to the NCPAP group, and that SNIPPV did not have a different negative effect on feeding intolerance than NCPAP.

References

  • 1.Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology 2019;115(4):432-450. doi: 10.1159/000499361.
  • 2.Gomella TL, Eyal FG, Bany-Mohammed F. Gomella Neonatoloji. Yenidoğan Hastalıklarına Genel Bakış. Respiratuvar Distres Sendromu, 6:117:1043,1044.1045.
  • 3. Özkan H, Erdeve Ö, Kanmaz Kutman HG. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment Turk Pediatri Ars 2018; 53(Suppl 1): S45-S54.
  • 4. Azzabi O, Selmi I, Bellali H, Siala N, Dridi Y, Fetni I, et al. Intubation-Surfactant-Extubation Strategy in a Medical Resource-limited Department: A Prospective Study. J Trop Pediatr 2016 Apr;62(2):169-70. doi: 10.1093/tropej/fmv074.
  • 5. Jena SR, Bains HS, Pandita A, Verma A, Gupta V, Kallem VR, et al. Surfactant therapy in premature babies: SurE or InSurE. Pediatr Pulmonol 2019 Nov;54(11):1747-1752. doi: 10.1002/ppul.24479.
  • 6. Behnke J, Lemyre B, Czernik C, Zimmer KP, Ehrhardt H, Waitz M. Non-Invasive Ventilation in Neonatology. Dtsch Arztebl Int 2019 Mar 8;116(11):177-183. doi: 10.3238/arztebl.2019.0177.
  • 7. Zhao YH, Liu YJ, Zhao XL, Chen WC, Zhou YC. Application of two noninvasive scores in predicting the risk of respiratory failure in full-term neonates: a comparative analysis. Zhongguo Dang Dai Er Ke Za Zhi 2022 Apr 15;24(4):423-427. doi: 10.7499/j.issn.1008-8830.2110023.
  • 8. Akisu M, Kumral A, Canpolat FE. Turkish Neonatal Society Guideline on neonatal encephalopathy. Turk Pediatri Ars 2018 Dec 25;53(Suppl 1):S32-S44. doi: 10.5152/TurkPediatriArs.2018.01805.
  • 9. Goldstein B, Giroir B, Randolph A, et al. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005 Jan;6(1):2-8. doi: 10.1097/01.PCC.0000149131.72248.E6.
  • 10. Oygür N , Önal EE, Zenciroğlu A. Turkish Neonatal Society national guideline for the delivery room management. Turk Pediatri Ars 2018; 53(Suppl 1): S3-S17
  • 11. Goldsmith J, P Karotkin E, Keszler M, Assisted Ventilation of the Neonate: Evidence-Based Approach to Newborn Respiratory Care Sixyh Edition, Philadelphia, United States, Elsevier- Health Science Division, Oxygen therapy and respiratory support,2017; 15:146-148.
  • 12. Ribeiro DFC, Barros FC, Fernandes BL, Nakato AM, Nohama P . Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial. . 2020 Jul 2;6(7):e04366. doi: 10.1016/j.heliyon.2020.e04366.
  • 13. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev 2013 Oct;89 Suppl 2:S13-20. doi: 10.1016/j.earlhumdev.2013.07.013.
  • 14. Koç E, Baş AY, Özdek Ş, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars 2018; 53(Suppl 1): S151-S160.
  • 15. Özek E, Kersin SG. Intraventricular hemorrhage in preterm babies. Turk Pediatri Ars 2020; 55(3): 215–21.
  • 16. Köksal N, Aygün C, Uras N. Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants. Turk Pediatri Ars 2018; 53(Suppl 1): S76-S87
  • 17. Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatr Rev 2017 Dec;38(12):552-559. doi: 10.1542/pir.2017-0002.
  • 18. Arsan S, Korkmaz A, Oğuz S. Turkish Neonatal Society guideline on prevention and management of bronchopulmonary. Turk Pediatri Ars 2018; 53(Suppl 1): S138-S150.
  • 19. Blennow M, Bohlin K. Surfactant and noninvasive ventilation. Neonatology 2015;107(4):330-6. doi: 10.1159/000381122.
  • 20. Dunn, MS, Kaempf J, De Klerk A, De Klerk R, Reilly M, Howard D, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011 Nov;128(5):e1069-76. doi: 10.1542/peds.2010-3848.
  • 21. Wiingreen R, Greisen G, Ebbesen F, Petersen JP, Zachariassen G, Henriksen TB, et al. Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013. Neonatology 2017;111(4):331-336. doi: 10.1159/000451021.
  • 22. Hermansen CL, Mahajan A. Newborn Respiratory Distress. Am Fam Physician 2015 Dec 1;92(11):994-1002.
  • 23. Verder H , Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrøm K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group. N Engl J Med 1994 Oct 20;331(16):1051-5. doi: 10.1056/NEJM199410203311603.
  • 24. Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics 1999 Feb;103(2):E24. doi: 10.1542/peds.103.2.e24.
  • 25. Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 2007 Oct 17;2007(4):CD003063. doi: 10.1002/14651858.CD003063.pub3.
  • 26. Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017 Jan;102(1):F17-F23. doi: 10.1136/archdischild-2015-310299.
  • 27. Roberts CT, Davis PG, Owen LS. Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013? Neonatology 2013;104(3):203-9. doi: 10.1159/000353448.
  • 28.Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2017 Feb 1;2(2):CD003212. doi: 10.1002/14651858.CD003212.pub3.
  • 29. Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 2013 May;162(5):949-54.e1. doi: 10.1016/j.jpeds.2012.11.016.
  • 30. Öktem A, Yiğit Ş, Çelik HT, Yurdakök M. Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants. Turk J Pediatr 2021;63(1):23-30. doi: 10.24953/turkjped.2021.01.003.
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Buse Soysal 0000-0002-0191-5283

Senem Alkan Özdemir 0000-0003-0474-7120

Tülin Gökmen Yıldırım 0000-0001-5951-2631

Şebnem Çalkavur 0000-0002-3820-2690

Publication Date September 27, 2022
Submission Date July 21, 2022
Published in Issue Year 2022 Volume: 1 Issue: 2

Cite

APA Soysal, B., Alkan Özdemir, S., Gökmen Yıldırım, T., Çalkavur, Ş. (2022). INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması. İzmir Tıp Fakültesi Dergisi, 1(2), 77-83.
AMA Soysal B, Alkan Özdemir S, Gökmen Yıldırım T, Çalkavur Ş. INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması. İzmir Tıp Fak. Derg. September 2022;1(2):77-83.
Chicago Soysal, Buse, Senem Alkan Özdemir, Tülin Gökmen Yıldırım, and Şebnem Çalkavur. “INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin Ve Komplikasyonlarının Karşılaştırılması”. İzmir Tıp Fakültesi Dergisi 1, no. 2 (September 2022): 77-83.
EndNote Soysal B, Alkan Özdemir S, Gökmen Yıldırım T, Çalkavur Ş (September 1, 2022) INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması. İzmir Tıp Fakültesi Dergisi 1 2 77–83.
IEEE B. Soysal, S. Alkan Özdemir, T. Gökmen Yıldırım, and Ş. Çalkavur, “INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması”, İzmir Tıp Fak. Derg., vol. 1, no. 2, pp. 77–83, 2022.
ISNAD Soysal, Buse et al. “INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin Ve Komplikasyonlarının Karşılaştırılması”. İzmir Tıp Fakültesi Dergisi 1/2 (September 2022), 77-83.
JAMA Soysal B, Alkan Özdemir S, Gökmen Yıldırım T, Çalkavur Ş. INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması. İzmir Tıp Fak. Derg. 2022;1:77–83.
MLA Soysal, Buse et al. “INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin Ve Komplikasyonlarının Karşılaştırılması”. İzmir Tıp Fakültesi Dergisi, vol. 1, no. 2, 2022, pp. 77-83.
Vancouver Soysal B, Alkan Özdemir S, Gökmen Yıldırım T, Çalkavur Ş. INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması. İzmir Tıp Fak. Derg. 2022;1(2):77-83.