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Outcomes and complications of invasive versus non-invasive respiratory support in extremely preterm infants: a

Huifen Chen1, Ming Zhang1, Dawei Wei1

  • 1Neonates Department, The fourth hospital of Shijiazhuang, Shijiazhuang, 050000, China.

BMC Pediatrics
|February 17, 2026
PubMed

Insights

Non-invasive ventilation, particularly non-invasive high-frequency oscillatory ventilation (NHFOV), improves outcomes for extremely preterm infants. This method reduces ventilation time and reintubation rates, optimizing care and minimizing complications.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Care
  • Critical Care

Background:

  • Extremely/very preterm infants have immature respiratory systems requiring respiratory support.
  • The comparative efficacy and safety of different ventilation modes remain debated.
  • Invasive mechanical ventilation (IMV), nasal continuous positive airway pressure (NCPAP), and non-invasive high-frequency oscillatory ventilation (NHFOV) are key support methods.

Purpose of the Study:

  • To compare the efficacy and safety of IMV, NCPAP, and NHFOV in extremely/very preterm infants.
  • To evaluate the impact of different ventilation strategies on infant prognosis and complications.

Main Methods:

  • Retrospective analysis of clinical data from 220 extremely/very preterm infants (January 2024 - March 2025).
  • Infants were stratified into three groups based on initial ventilation: IMV (AG, n=87), NCPAP (BG, n=82), and NHFOV (CG, n=51).
  • Outcomes and complications were compared across the ventilation groups.

Main Results:

  • The NHFOV group (CG) showed significantly shorter total ventilation time (8.5 days), lower reintubation rates (17.6%), and higher weaning success rates (88.2%) compared to other groups (P<0.05).
  • The IMV group (AG) had the highest incidence of bronchopulmonary dysplasia (37.9%) and intracranial hemorrhage (13.8%) (P<0.05).
  • No significant differences were observed in mortality, necrotizing enterocolitis, retinopathy of prematurity, or sepsis incidence among the groups (P>0.05).

Conclusions:

  • Non-invasive ventilation, especially NHFOV, is associated with improved treatment outcomes and reduced complications in extremely/very preterm infants.
  • NHFOV demonstrates superior results in terms of ventilation duration, reintubation, and weaning success.
  • Preferential use of NHFOV is recommended for optimizing care in this vulnerable population.
Abstract

Keywords:
Extremely preterm infantInvasive mechanical ventilationNasal continuous positive airway pressureNon-invasive high-frequency oscillatory ventilationVery preterm infant

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