Citation Information :
Skariah TA, Lewis L, Sasi A. Noninvasive ventilation in preterm neonates - Nasal continuous positive airway pressure vS Nasal intermittent positive pressure ventilation – A randomised controlled trial. Indian J Respir Care 2013; 2 (1):206-212.
Background: Noninvasive ventilation (NIV) has been used in preterm neonates in the past few decades, with the main objective of reducing the exposure to invasive ventilation. It proves to be safe and effective but the best option is yet to be determined.
Objective: To determine, if nasal intermittent positive pressure ventilation (NIPPV) decreases the need for mechanical ventilation in the first 48 h when given as a respiratory support post-extubation in preterm neonates compared to nasal continuous positive airway pressure (NCPAP). It is a randomised controlled trial.
Method: Preterm neonates (gestational age 28-36 weeks) with respiratory distress requiring invasive ventilation were randomly assigned to receive NIPPV or NCPAP as postextubation respiratory support. The primary outcome was the need for mechanical ventilation within the first 48 hours of life.
Results: A total of 32 neonates in postextubation NIV group after stratification to gestational age of 28-32 weeks and 33-36 weeks. The need for invasive mechanical ventilation in the first 48 h was not different in both NIPPV (11.1%) and NCPAP (7.1%). The complications associated with these modes were also compared and analysed. There was no difference noted.
Conclusions: NIPPV did not decrease the need for mechanical ventilation compared to NCPAP, overall, in the first 48 hours of support. It could be considered as safe and beneficial compared to NCPAP. However, further studies have to assess the potential benefits and complications associated with NIPPV in preterm neonates.
Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003; 2: CD000143.
Higgins RD, Richter SE, Davis JM. Nasal continuous positive airway pressure facilitates extubation of very low birth weight neonates. Pediatrics 1991; 88:999-1003.
Kirchner L, Weninger M, Unterasinger L, et al. Is the use of early nasal CPAP associated with lower rates of chronic lung disease and retinopathy of prematurity? Nine years of experience with the Vermont Oxford Neonatal Network. J Perinat Med 2005; 33:60-6.
Fox WW, Schwartz JG, Shaffer TH. Successful extubation of neonates: clinical and physiological factors. Crit Care Med 1981; 9:823-6.
Kattwinkel J, Nearman HS, Fanaroff AA, et al. Apnea of prematurity. Comparative therapeutic effects of cutaneous stimulation and nasal continuous positive airway pressure. J Pediatr 1975; 86:588-92.
Finer NN, Moriartey RR, Boyd J, et al. Postextubation atelectasis: a retrospective review and a prospective controlled study. J Pediatr 1979;94:110-3.
Criner GJ, Brennan K, Travaline JM, et al. Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure. Chest 1999; 116:667-75.
Bott J, Carroll MP, Conway JH, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 1993; 341:1555-7.
E llis ER, Grunstein RR, Chan S, et al. Noninvasive ventilatory support during sleep improves respiratory failure in kyphoscoliosis. Chest 1988; 94:811-5.
Piper AJ, Parker S, Torzillo PJ, et al. Nocturnal nasal IPPV stabilizes patients with cystic fibrosis and hypercapnic respiratory failure. Chest 1992; 102:846-50.
Keenan SP, Kernerman PD, Cook DJ, et al. Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta analysis. Crit Care Med 1997; 25:1685-92.
Tibballs J, Henning RD. Noninvasive ventilatory strategies in the management ofa newborn infant and three children with congenital central hypoventilation syndrome. Pediatr Pulmonol 2003; 36:544-8.
Bancalari E, Claure N. Non-invasive ventilation of preterm infant. Early Hum Dev 2008; 84:815- 819.
Di Blasi RM. Neonatal Noninvasive Ventilation Techniques: Do we really need to intubate? Respiratory Care 2011; 56:1273-97.
Kishore MSS, Dutta S, Kumar P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatrica 2009, 98:1412-5.
Santin R, Brodsky N, Bhandari V. A prospective observational pilot study of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a primary mode of ventilation in infants or = 28 weeks with respiratory distress syndrome (RDS). J Perinatol 2004; 24:487- 93.
Davis PG, Lemyre B, De Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus Nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. The Cochrane Library 2009 Issue 2.
Lemyre B, Davis PG, De Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurity. Cochrane Database Syst Rev 2002, Issue 1. Art. No.: CD002272.
Aghai ZH, Saslow JG, Nakhla T, et al. Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) Decreases Action of Breathing (AOB) in Premature Infants with Respiratory Distress Syndrome (RDS) Compared to Nasal Continuous Positive Airway Pressure (NCPAP). Pediatric Pulmonology 2006; 41:875-81.
Garland JS, Nelson DB, Rice T, et al. Increased risk of gastrointestinal perforations in neonates mechanically ventilated with either face mask or nasal prongs. Pediatrics 1985; 76:406-10.
Santin R, Brodsky N, Bhandari V. A prospective observational pilot study of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a primary mode of ventilation in infants or = 28 weeks with respiratory distress syndrome (RDS). J Perinatol 2004; 24:487-93.
