Predictors and outcomes of successful primary nasal intermittent positive pressure ventilation in extremely preterm infants: A retrospective observational study.

Abstract

Objectives: This study aimed to evaluate the effectiveness and short-term outcomes of primary nasal intermittent positive pressure ventilation (NIPPV) in extremely preterm (EP) infants with respiratory distress syndrome (RDS).

Methods: A retrospective case-control study was conducted at the Women's Wellness and Research Center in Qatar, from January 2017 to December 2019. Primary NIPPV success was defined as the absence of surfactant administration or mechanical ventilation within the first 72 hours of life.

Results: Of 367 infants requiring respiratory support at birth, 69 were managed with primary NIPPV. Among them, 62.3% succeeded (NIPPV-S) and 37.7% failed (NIPPV-F). Birth weights (956 g vs. 937 g) and gestational ages (26.3 weeks vs. 26.2 weeks) were similar between groups. NIPPV-S babies had more vaginal deliveries (48.8% vs. 19.2%, p = 0.014), higher arterial pH levels (7.36 vs. 7.29, p < 0.001), lower initial FiO₂ (27.8% vs. 35.3%, p < 0.001), and less severe RDS (2.5% vs. 28.6%, p = 0.006). They also received caffeine earlier (2.6 hours vs. 4.3 hours, p = 0.042) and were more often in room air at day 28 (34.9% vs. 8.2%, p = 0.016). In the NIPPV-F group, 65% were intubated within 12 hours. NIPPV-S infants also had lower rates of brain injury (14.6% vs. 45.8%, p = 0.006) and bronchopulmonary dysplasia (BPD) (18.6% vs. 41.7%, p = 0.041), with a trend towards reduced death or severe BPD (2.3% vs. 15.4%, p = 0.063). Multivariate analysis identified admission FiO₂ less than 0.4, vaginal delivery, and normal fetal Doppler as significant predictors of NIPPV success.

Conclusions: Among EP infants managed with primary NIPPV, success within the first 72 hours was associated with lower initial FiO₂, vaginal delivery, and normal fetal Doppler findings. EP infants who succeeded on NIPPV had less severe RDS and better outcomes, including lower rates of brain injury and BPD. Early identification of infants likely to succeed may improve clinical outcomes.