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A trial comparing noninvasive ventilation strategies in preterm infants
Haresh Kirpalani1, David Millar, Brigitte Lemyre
1Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. kirpalanih@email.chop.edu
Insights
Nasal intermittent positive-pressure ventilation (IPPV) and nasal continuous positive airway pressure (CPAP) showed similar outcomes for extremely-low-birth-weight infants. Survival without bronchopulmonary dysplasia did not significantly differ between the two noninvasive respiratory support methods.
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.
Background:
To reduce the risk of bronchopulmonary dysplasia in extremely-low-birth-weight infants, clinicians attempt to minimize the use of endotracheal intubation by the early introduction of less invasive forms of positive airway pressure.
Methods:
We randomly assigned 1009 infants with a birth weight of less than 1000 g and a gestational age of less than 30 weeks to one of two forms of noninvasive respiratory support--nasal intermittent positive-pressure ventilation (IPPV) or nasal continuous positive airway pressure (CPAP)--at the time of the first use of noninvasive respiratory support during the first 28 days of life. The primary outcome was death before 36 weeks of postmenstrual age or survival with bronchopulmonary dysplasia.
Results:
Of the 497 infants assigned to nasal IPPV for whom adequate data were available, 191 died or survived with bronchopulmonary dysplasia (38.4%), as compared with 180 of 490 infants assigned to nasal CPAP (36.7%) (adjusted odds ratio, 1.09; 95% confidence interval, 0.83 to 1.43; P=0.56). The frequencies of air leaks and necrotizing enterocolitis, the duration of respiratory support, and the time to full feedings did not differ significantly between treatment groups.
Conclusions:
Among extremely-low-birth-weight infants, the rate of survival to 36 weeks of postmenstrual age without bronchopulmonary dysplasia did not differ significantly after noninvasive respiratory support with nasal IPPV as compared with nasal CPAP. (Funded by the Canadian Institutes of Health Research; NIPPV ClinicalTrials.gov number, NCT00433212; Controlled-Trials.com number, ISRCTN15233270.).
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