Prolonged Intermittent Positive Pressure Ventilation by Nasal Prongs in Intractable Apnea of Prematurity

Abstract

In order to avoid endotracheal intubation in very small newborn infants requiring prolonged intermittent positive pressure ventilation (IPPV), a method was developed allowing delivery of IPPV by means of nasal prongs (nasal IPPV). A series of 10 newborn infants weighing 1 200 g or less, and requiring nasal IPPV for 5 to 14 days because of intractable apnea has been reported. Five infants survived. With the exception of hearing defects in two survivors, no lesions possibly due to the ventilation procedure were observed. Follow-up examination showed severe mental and motor handicap in one infant, and apparently normal mental and motor development in 3 infants examined at the age of 12-27 months. It is suggested that nasal IPPV is an effective and safe method for prolonged ventilation of very small newborn infants with normal or not severely affected lungs, whereas it appears of very limited use in patients with stiff lungs, such as in severe HMD.

Neonatal Noninvasive Ventilation Techniques: Do We Really Need to Intubate?

“…Attempts were made during this time to develop new techniques for securing the face mask that would decrease the risk of head molding and consequent neurologic complications during NIV. 27 Following the initial description of nasal prongs by Kattiwinkel et al 28 and Caliumi-Pellegrini et al 29 to deliver CPAP, Moretti et al 30 described the first successful application of NIV with bi-nasal prongs in preterm neonates with respiratory failure and apnea. The widespread use of NIV was temporarily hampered following the publication of a paper by Garland et al, 31 who found that neonates ventilated with either oronasal mask or nasal prongs were 30 times more likely to develop gastrointestinal perforations than were neonates ventilated with ETT.…”

“…48 Additionally, higher inspiratory flow may produce a fast rise in the airway pressure so that the soft palate can be pushed against the tongue and seal the oral cavity, resulting in better breath delivery during an obstructive apnea. 30 IMV augments a neonate's spontaneous respiratory effort or increases "sighing," which may be useful for recruiting and maintaining distal air spaces and preventing apnea.…”

“…Moretti et al 30 conducted an observational study wherein 10 premature neonates with moderate apnea and one neonate with progressive respiratory failure were placed on nasal IMV for 5 days. Endotracheal intubation was never performed in any of the patients during the study period, and no evidence of BPD was observed.…”

Synchronized Nasal Intermittent Positive Pressure Ventilation of the Newborn: Technical Issues and Clinical Results

“…Following the description of nasal prongs by Kattwinkel et al [3] and Caliumi-Pellegrini et al [4] to deliver NCPAP, in 1981 our group carried out the first successful application of NIPPV with short bi-nasal prongs in 10 very low birth weight (VLBW) infants who had severe apnea spells despite NCPAP and methylxanthines [5]. In most cases the underlying clinical problem was sepsis, and NIPPV was given for 5-14 days.…”

Effects of Continuous Positive Airway Pressure on Renal Function in Prematures

“…The CPAP therapy effects on other organs must be considered too, such as its circula tory effects of increasing venous pressure in the cranium and upper extremities, and a fact known from animal experiments only: that of decreased cardiac stroke volume [1,3,7,18,19,21,23,24,28],…”