Mechanical ventilation is associated with increased survival of preterm infants but is also associated with an increased incidence of chronic lung disease (bronchopulmonary dysplasia) in survivors. Nasal continuous positive airway pressure (nCPAP) is a form of noninvasive ventilation that reduces the need for mechanical ventilation and decreases the combined outcome of death or bronchopulmonary dysplasia. Other modes of noninvasive ventilation, including nasal intermittent positive pressure ventilation, biphasic positive airway pressure, and high-flow nasal cannula, have recently been introduced into the NICU setting as potential alternatives to mechanical ventilation or nCPAP. Randomized controlled trials suggest that these newer modalities may be effective alternatives to nCPAP and may offer some advantages over nCPAP, but efficacy and safety data are limited.

https://pediatrics.aappublications.org/content/pediatrics/early/2015/12/28/peds.2015-3758.full.pdf

Noninvasive Respiratory Support

Objective To determine among preterm infants with respiratory distress syndrome whether the use of early nasal intermittent positive-pressure ventilation (NIPPV) vs nasal continuous positive airway pressure (NCPAP) decreases the need for invasive ventilation within the first 72 hours of life. Data Sources MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were searched, as well as abstracts from meetings of the Pediatric Academic Societies. Study Selection Randomized controlled trials involving infants with respiratory distress syndrome who received NIPPV vs NCPAP. Data Extraction Data were extracted on the use of NIPPV vs NCPAP. Also extracted were data on the need for invasive ventilation within the first 72 hours of life and the incidences of bronchopulmonary dysplasia, pneumothorax, necrotizing enterocolitis, and intraventricular hemorrhage, as well as the time to full feeds and the duration of hospital stay. Data Synthesis Three trials were included (n = 360). A significant decrease in the need for invasive ventilation was found in the NIPPV group (risk ratio, 0.60; 95% CI, 0.43-0.83). No difference between groups was found in the incidence of bronchopulmonary dysplasia (risk ratio, 0.56; 95% CI, 0.09-3.49). No differences in the other outcomes were observed between the 2 groups. Conclusions Among preterm infants with respiratory distress syndrome, NIPPV decreases the need for invasive ventilation within the first 72 hours of life compared with NCPAP. Trials are needed to assess whether NIPPV minimizes the occurrence of bronchopulmonary dysplasia and other comorbidities.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/1148406/pra110007_372_376.pdf

Nasal Intermittent Positive-Pressure Ventilation vs Nasal Continuous Positive Airway Pressure for Preterm Infants With Respiratory Distress Syndrome: A Systematic Review and Meta-analysis

SummaryObjective
To evaluate whether nasal intermittent positive pressure ventilation (NIPPV) compared with nasal continuous positive airway pressure (nCPAP) decreases the requirement for endotracheal ventilation in preterm and term infants with respiratory distress syndrome (RDS).

Methods
This was a single center, randomized, controlled trial. A total of 179 preterm and term infants with RDS were randomized to NIPPV (n = 88) or nCPAP (n = 91). The clinical data of enrolled infants including blood gas analysis, PaO2/FiO2 ratio, incidence of intubation, and complications, if occurred, were recorded. The primary outcome was the need for endotracheal ventilation. The secondary outcome was the measurement of favorable outcome, which was defined as discharged without any respiratory support and feeding well and gaining weight. Analysis followed slightly modified intention to treat principle.

Results
Significantly less number of infants randomized to NIPPV group required intubation and mechanical ventilation compared with nCPAP group (11.4% vs. 20.9%, P < 0.05). A favorable outcome was more likely in infants randomized to NIPPV (93.2% vs. 84.6%, P < 0.05). In subgroup analysis, NIPPV was associated with reduced need for intubation in preterm (9.9% vs. 19.2%) and term (17.6% vs. 27.8%) infants, but the difference was statistically significant only in preterm infants(P < 0.05).

Conclusion
Treatment with NIPPV compared with nCPAP decreased the need for endotracheal ventilation and increased favorable outcome in preterm and term infants with RDS. Pediatr Pulmonol. 2014; 49:673–678. © 2013 Wiley Periodicals, Inc.

A prospective, randomized, controlled study of NIPPV versus nCPAP in preterm and term infants with respiratory distress syndrome

Objective
To compare the efficacy and safety of Nasal intermittent positive pressure ventilation (NIPPV) and Nasal continuous positive airway pressure (nCPAP) in neonates.

/pdf/nasal-intermittent-positive-pressure-ventilation-versus-1lu699hfax.pdf

Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in neonates: A systematic review and meta-analysis

https://www.perinatology.theclinics.com/article/S0095-5108(12)00058-9/pdf

Noninvasive respiratory support in the preterm infant.

Evaluating a new blood gas sensor.

Objective: Physiologic and pathologic comparison of two modes of assisted ventilation, nasal intermittent positive-pressure ventilation (NIPPV) and synchronized intermittent mandatory ventilation (SIMV), in spontaneously breathing term newborn piglets with saline lavage-induced lung injury. Design: After inducing acute lung injury via repetitive saline lavage, piglets were randomized to NIPPV (n 12) or SIMV (n 11) and treated for 6 hrs. Setting: Clinical laboratory. Subjects: Spontaneously breathing term newborn piglets. Interventions: Invasive (SIMV) or noninvasive (NIPPV) assisted ventilation for 6 hrs. Measurements: Physiologic parameters and arterial blood gases were continuously monitored. At the conclusion of the study, lung tissue was obtained to analyze for evidence of inflammation, including myeloperoxidase, interleukin-8, and hydrogen peroxide levels, as well as for evidence of pathologic injury. Main Results: Piglets treated with NIPPV demonstrated higher arterial blood gas pH (p < .001), lower PaCO2 (p < .05), and a lower set respiratory rate (p < .0001) as compared with the SIMV-treated piglets. The piglets in the SIMV group had higher PaO2/PAO2 ratio than those in the NIPPV group (p .001). There was significantly more interstitial inflammation (p .04) in the SIMV-treated piglets compared with the NIPPV-treated piglets. Total respiratory rate, heart rate, blood pressure, oxygen saturation, and biochemical markers of lung inflammation were not different between the groups. Conclusion: In surfactant-deficient term newborn piglets, NIPPV offers an effective and noninvasive ventilatory strategy with the potential for less pathologic lung inflammation. (Crit Care Med 2008; 36:183‐187)

http://newbornmed.com/wp-content/uploads/2010/02/00003246-200801000-000251.pdf

Gas exchange and lung inflammation using nasal intermittent positive-pressure ventilation versus synchronized intermittent mandatory ventilation in piglets with saline lavage-induced lung injury: an observational study.

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Evaluating a new blood gas sensor.

Gas exchange and lung inflammation using nasal intermittent positive-pressure ventilation versus synchronized intermittent mandatory ventilation in piglets with saline lavage-induced lung injury: an observational study.