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Predictors and outcomes of successful primary nasal intermittent positive pressure ventilation in extremely preterm

Ratheesh Paramban1, Jojo Furigay1, Sabry Nasr1

  • 1Department of Critical Care, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar *Email: agad2@hamad.qa.

Qatar Medical Journal
|September 19, 2025
PubMed

Insights

Primary nasal intermittent positive pressure ventilation (NIPPV) is effective for extremely preterm infants with respiratory distress syndrome (RDS). Success with NIPPV is linked to better short-term outcomes, including reduced brain injury and bronchopulmonary dysplasia.

Area of Science:

  • Neonatology
  • Pediatric Respiratory Medicine

Background:

  • Respiratory distress syndrome (RDS) is a common condition in extremely preterm (EP) infants.
  • Nasal intermittent positive pressure ventilation (NIPPV) is a non-invasive respiratory support method used in neonates.

Purpose of the Study:

  • To evaluate the effectiveness and short-term outcomes of primary NIPPV in EP infants with RDS.
  • To identify predictors of NIPPV success in this population.

Main Methods:

  • Retrospective case-control study of 69 EP infants managed with primary NIPPV.
  • NIPPV success defined as no surfactant or mechanical ventilation within 72 hours.
  • Comparison of clinical characteristics and outcomes between NIPPV success and failure groups.

Main Results:

  • 62.3% of EP infants achieved primary NIPPV success.
  • NIPPV success was associated with vaginal delivery, higher arterial pH, lower initial FiO2, and less severe RDS.
  • NIPPV success group had lower rates of brain injury and bronchopulmonary dysplasia (BPD).
  • Predictors of success included admission FiO2 < 0.4, vaginal delivery, and normal fetal Doppler.

Conclusions:

  • Primary NIPPV is a viable strategy for EP infants with RDS, with a success rate of 62.3%.
  • Favorable outcomes, including reduced brain injury and BPD, are associated with NIPPV success.
  • Early identification of infants likely to benefit from NIPPV can potentially improve clinical outcomes.
Abstract

Keywords:
Extremely pretermcontinuous positive airway pressurenasal intermittent positive pressure ventilationneonatesrespiratory distress syndromesurfactant

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