Noninvasive ventilation in preterm neonates - Nasal continuous positive airway pressure vS Nasal intermittent positive pressure ventilation – A randomised controlled trial

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.