SOVREMENNAYA PEDIATRIYA.2016.4(76):91-96; doi10.15574/SP.2016.76.91 

Choosing the type of respiratory support for preterm infants after extubation: non-invasive ventilation versus continuous positive airway pressure

Menshykova A. O., Dobryanskyy D. O., Salabay Z. V., Novikova O. V., Dybrovna Y. Y.

Department of Pediatrics, Lviv National Medical University

Neonatal Intensive Care Unit, Lviv Regional Clinical Hospital, Ukraine, Lviv 

Mechanical ventilation is associated with increased risk of secondary lung injury in preterm infants. It is important to reduce duration of this intervention through effective application of non-invasive respiratory support. This open randomized study compared clinical efficacy of non-synchronized non-invasive ventilation (NV) and continuous positive airway pressure (CPAP) after primary extubation of very preterm infants. The study included 80 very preterm infants with birth weight <1500 g, gestation age <32 weeks and respiratory distress syndrome. Before the first extubation infants were randomized into the non+synchronized NV (n=40) or the CPAP (n=40) group. One of the aforementioned modes of respiratory support was used according to the protocol for at least 48 hrs. The primary study outcome was the need for re-intubation within 72 hrs after initial extubation. Mortality, incidences of bronchopulmonary dysplasia (BPD) and other important complications of prematurity were also compared in these groups.

Results. The frequency of re-intubation within the first 72 hrs of non+invasive respiratory support was almost similar in the both groups (11 cases (27.5%) in the NV group compared to 12 cases (30%) in the CPAP group; р>0.05). No difference in total duration of respiratory support was observed between the groups either. No significant difference in BPD incidence according to the clinical definition was found between the groups (9 cases (22.5%) in the NV group compared to 7 cases (17.5%) in the CPAP group; р>0.05). BPD incidence according to the physiological definition was the same in the both groups (2.5%).

Conclusions: Non+synchronized non-invasive ventilation after primary extubation of very preterm infants during first three days of life has no obvious clinical advantages over the extubation followed by continuous positive airway pressure.

Key words: respiratory support, non-invasive ventilation, continuous positive airway pressure, respiratory distress syndrome, infants with very low birth weight.

REFERENCES

1. Abdel-Hady H, Nasef N. 2012. Respiratory management of the preterm newborn in the delivery room. Research and Reports in Neonatology. 2: 39—53.

2. Khalaf MN, Brodsky N, Hurley J, Bhandari V. 2001. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics. 108: 13—17.

3. Shi Y, Tang S, Zhao J, Shen J. 2014. A prospective, randomized, controlled study of NIPPV versus nCPAP in preterm and term infants with respiratory distress syndrome. Pediatr Pulmonol. 49: 673—678.

4. Stefanescu BM, Murphy WP, Hansell BJ et al. 2003. A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics. 112: 1031—1038.

5. Anderson C, Sweet D. Non-invasive respiratory support in preterm babies. http://www.cureandcareportal.com/non-invasive-respiratory-support-preterm-babies-2/.

6. Khorana M, Paradeevisut H, Sangtawesin V et al. 2008. A randomized trial of non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV) vs. nasal continuous positive airway pressure (NCPAP) in the prevention of extubation failure in pre-term <1.500 grams. J Med Assoc Thai. 91: 136—142.

7. A review on noninvasive ventilation: The Cochrane Systematic Reviews 2006. J Perinatol. 2007. 27: 21—25.

8. Kirpalani H, Millar D, Lemyre B et al. 2013. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med. 369: 611—620.

9. Attar MA, Donn SM. 2002. Mechanisms of ventilator-induced lung injury in premature infants. Semin Neonatol. 7: 353—360.

10. Bancalari E, Claure N. 2008. Non-invasive ventilation of the preterm infant. Early Human Development. 84: 815—819.

11. Barrington KJ, Bull D, Finer NN. 2001. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics. 107: 638—641.

12. Bisceglia M, Belcastro A, Poerio V. 2007. A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants. Minerva Pediatr. 59: 91—95.

13. Cummings JJ, Polin RA. 2016. Noninvasive Respiratory Support. Pediatrics. 137: 1—11.

14. DiBlasi R. 2011. Neonatal noninvasive ventilation techniques: do we really need to intubate? Respiratory Care. 56(9): 1273—1297.

15. Stevens TP, Harrington EW, Blennow M, Early RF. 2007. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Systematic Reviews. 17(4): СD003063

16. O'Brien K, Campbell C, Brown L et al. Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants' <1.250 grams: a randomized controlled trial. http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-12-43.

17. Avery ME, Tooley WH, Keller JB et al. 1987. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics. 79: 26—30.

18. Jobe AH, Bancalari E. 2001. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 163(7): 1723—1729.

19. Kishore SS, Dutta S, Kumar P. 2009. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatr. 98: 1412—1415.

20. Kugelman A. 2009. International perspectives: nasal ventilation in preterm infants: An Israel perspective. NeoReviews. 10: 157—165.

21. Meneses J, Bhandari V, Alves JG. 2012. Nasal intermittent positive pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome. Arch Pediatr Adolesc Med. 166: 372—376.

22. Kugelman A, Feferkorn I, Riskin A. 2007. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study. J Pediatr. 150: 521—526.

23. Lemyre B, Devis PG, De Paoli AG, Kirpalani H. 2014. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Systematic Reviews. http://www.ncbi.nlm.nih.gov/pubmed/25188554.

24. Duman N, Tuzun F, Sever AH et al. 2015. Nasal intermittent positive pressure ventilation with or without very early surfactant therapy for the primary treatment of respiratory distress syndrome. J Matern Fetal Neonatal Med. 27: 1—6.

25. NHFOV versus NCPAP to prevent extubation failure. http://clinicaltrials.gov/show/NCT01852916.

26. Meneses J, Bhandari V, Guilherme J et al. 2011. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatrics. 127: 300—307.

27. Owen LS, Morley CJ, Davis PG. 2008. Neonatal nasal intermittent positive pressure ventilation: a survey of practice in England. Arch Dis Child Fetal Neonatal Ed. 93: 148—150.

28. Owen LS, Morley CJ, Davis PG. 2010. Pressure variation during ventilator generated nasal intermittent positive pressure ventilation in preterm infants. Arch Dis Child Fetal Neonatal Ed. 95: 359—364.

29. Ramanathan R. 2007. Early surfactant therapy and noninvasive ventilation. J Perinatol. 27: 33-—37.

30. Ramanathan R. 2010. Nasal respiratory support through the nares: its time has come. J Perinatol. 30: 67—72.

31. Pantalitschka T, Sievers J, Urschitz MS et al. 2009. Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 94: 245—248.

32. Walsh MC, Wilson-Costello D, Zadell A et al. 2003. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol. 23: 451—456.

33. Sinha SK, Gupta S, Donn SM. 2008. Immediate respiratory management of the preterm infant. Seminars in Fetal & Neonatal Medicine. 13: 24—29.

34. Richardson DK, Corcoran JD, Escobar GJ, Lee SK. 2001. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risks cores. J Pediatr. 138: 92—100.

35. Dumpa V, Katz K, Northrup V, Bhandari V. 2012. SNIPPV vs NIPPV: does synchronization matter? J Perinatol. 32: 438—442.

36. Bhandari V, Finer NN, Ehrenkranz RA et al. 2009. Synchronized nasal intermittent positive pressure ventilation and neonatal outcomes: a retrospective study. Pediatrics. 124: 517—526.

37. Gregory GA, Kitterman JA, Phibbs RH et al. 1971. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 284: 1333—1340.

llege of Physicians of London (2004), Registered charity No. 210508, 92 pages.