A trial comparing noninvasive ventilation strategies in preterm infants

Area of Science:

• Neonatalogy
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Bronchopulmonary dysplasia (BPD) is a significant risk for extremely-low-birth-weight (ELBW) infants.
• Minimizing endotracheal intubation via less invasive positive airway pressure is a clinical goal.

Purpose of the Study:

• To compare the efficacy of nasal intermittent positive-pressure ventilation (IPPV) versus nasal continuous positive airway pressure (CPAP) in ELBW infants.
• To assess the primary outcome of death or survival with BPD at 36 weeks postmenstrual age.

Main Methods:

• Randomized trial of 1009 infants (<1000g birth weight, <30 weeks gestational age).
• Infants received either nasal IPPV or nasal CPAP upon first noninvasive respiratory support.
• Primary outcome: death before 36 weeks postmenstrual age or survival with BPD.

Main Results:

• No significant difference in death or BPD rates between nasal IPPV (38.4%) and nasal CPAP (36.7%) groups.
• Adjusted odds ratio for nasal IPPV vs. CPAP was 1.09 (95% CI, 0.83 to 1.43; P=0.56).
• No significant differences in air leaks, necrotizing enterocolitis, respiratory support duration, or time to full feedings.

Conclusions:

• Nasal IPPV and nasal CPAP demonstrate comparable rates of survival without BPD in ELBW infants.
• Both noninvasive methods are viable options for respiratory support in this vulnerable population.