Response of Preterm Infants to 2 Noninvasive Ventilatory Support Systems: Nasal CPAP and Nasal Intermittent Positive-Pressure Ventilation

Abstract

BACKGROUND: Noninvasive ventilation (NIV) in preterm infants is currently applied using intermittent positive pressure (2 positive-pressure levels) or in a conventional manner (one pressure level). However, there are no studies in the literature comparing the chances of failure of these NIV methods. The aim of this study was to evaluate the occurrence of failure of 2 noninvasive ventilatory support systems in preterm neonates over a period of 48 h. METHODS: A randomized, prospective, clinical study was conducted on 80 newborns (gestational age < 37 weeks, birthweight < 2,500 g). The infants were randomized into 2 groups: 40 infants were treated with nasal CPAP and 40 infants with nasal intermittent positive-pressure ventilation (NIPPV). The occurrence of apnea, progression of respiratory distress, nose bleeding, and agitation was defined as ventilation failure. The need for intubation and re-intubation after failure was also observed. RESULTS: There were no significant differences in birth characteristics between groups. Ventilatory support failure was observed in 25 (62.5%) newborns treated with nasal CPAP and in 12 (30%) newborns treated with NIPPV, indicating an association between NIV failure and the absence of intermittent positive pressure (odds ratio [OR] 1.22, P < .05). Apnea (32.5%) was the main reason for nasal CPAP failure. After failure, 25% (OR 0.33) of the newborns receiving nasal CPAP and 12.5% (OR 0.14) receiving NIPPV required invasive mechanical ventilation. CONCLUSIONS: Ventilatory support failure was significantly more frequent when nasal CPAP was used.

Efficacy of noninvasive respiratory support modes as postextubation respiratory support in preterm neonates: A systematic review and network meta‐analysis

“…A total of 8418 studies were identified through searching the different databases. After excluding studies for relevant reasons, a total of 33 studies were included in the final synthesis 21‐53 . The literature search flow is shown in Figure S1.…”

“…Ten studies were adjudged as having a high risk of bias due to issues in random sequence generation and allocation concealment 30,32,33,39,40,43‐45,47,53 . Eight studies had a low risk of bias 21,23,25,26,42,48,50,52 and fifteen studies had variable risk of bias 22,24,27‐29,31,34‐38,41,46,49,51 .…”

“…Ten studies were adjudged as having a high risk of bias due to issues in random sequence generation and allocation concealment. 30,32,33,39,40,[43][44][45]47,53 Eight studies had a low risk of bias 21,23,25,26,42,48,50,52 and fifteen studies had variable risk of bias. 22,24,[27][28][29]31,[34][35][36][37][38]41,46,49,51 Due to the nature of the intervention, blinding of the personnel and outcome assessor was not possible and hence all the trials scored a high risk of bias for the same.…”

Current insights in non-invasive ventilation for the treatment of neonatal respiratory disease

“…NIMV compared to NCPAP as initial treatment for RDS in preterm newborns of < 35 weeks of gestation demonstrated decreased need for intubation and decreased BPD rate with NIMV [29]. Silveira et al [30] found that for preterm infants of gestational age < 37 weeks and birth weight < 2500 g, failure on NIPPV support compared to CPAP was less likely and the rate of intubation was higher when using CPAP. Moreover, occurrence of apnea episodes was lower in the NIPPV group.…”

Noninvasive Respiratory Support for Newborns

“…44-53 In the updated search, we identified 6 new eligible studies. 54-58 These form the basis of this review.…”