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Am J Perinatol 2022; 39(16): 1828-1834
DOI: 10.1055/s-0041-1727159
Original Article

Comparison of High CPAP versus NIPPV in Preterm Neonates: A Retrospective Cohort Study

Hussain Alsaid Ahmad
1   Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Veena Deekonda
2   Department of Respiratory Therapy, Hamilton Health Sciences, Hamilton, Ontario, Canada
,
Waseemoddin Patel
3   Division of Neonatology, Department of Pediatrics, Princess Nourah Bint AbdulRahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
,
Lehana Thabane
1   Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
Prakesh S. Shah
4   Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Amit Mukerji
1   Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Abstract

Objective The aim of this study was to compare outcomes following receipt of high continuous positive airway pressure (CPAP) versus nasal intermittent positive pressure ventilation (NIPPV) in extremely preterm neonates.

Study Design We retrospectively compared outcomes of preterm neonates (22–28 weeks' gestation) following their first episode of either high CPAP (≥ 9 cm H2O) or NIPPV. Primary outcome was failure of high CPAP or NIPPV within 7 days, as determined by either need for intubation or use of an alternate noninvasive mode.

Results During the 3-year study period, 53 infants received high CPAP, while 119 patients received NIPPV. There were no differences in the primary outcome (adjusted odds ratio 1.21; 95% confidence interval 0.49–3.01). The use of alternate mode of noninvasive support was higher with the use of high CPAP but no other outcome differences were noted.

Conclusion Based on this cohort, there was no difference in incidence of failure between high CPAP and NIPPV, although infants receiving high CPAP were more likely to require an alternate mode of noninvasive support.

Key Points

  • Use of high CPAP pressures (defined as ≥9 cm H2O) is gradually increasing during care of preterm neonates.

  • Limited data exists regarding its efficacy and safety.

  • This study compares high CPAP with NIPPV, and demonstrates comparable short-term clinical outcomes.

Keywords

noninvasive respiratory support - continuous positive airway pressure - noninvasive positive pressure ventilation - distending pressure - invasive mechanical ventilation

Authors' Contributions

H.A.A. performed the primary data collection for all subjects, and wrote the first draft of the manuscript. V.D. and W.P. assisted in data collection and provided input in study design. L.T. and P.S. contributed to study design/methodology and analysis plan. A.M. devised the study concept, performed statistical analyses, and revised the manuscript into its final form.


Supplementary Material



Publication History

Received: 27 August 2020

Accepted: 22 February 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
    CrossrefPubMedSearch in Google Scholar
  • 2 Canadian Neonatal Network 2017 Annual Report. Accessed on March 22, 2021 at: http://www.canadianneonatalnetwork.org/portal/
    PubMed
  • 3 Mukerji A, Shah PS, Shivananda S. et al; Canadian Neonatal Network Investigators. Survey of noninvasive respiratory support practices in Canadian neonatal intensive care units. Acta Paediatr 2017; 106 (03) 387-393
    CrossrefPubMedSearch in Google Scholar
  • 4 Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev 2011; 12 (03) 196-205
    CrossrefPubMedSearch in Google Scholar
  • 5 Binmanee A, El Helou S, Shivananda S, Fusch C, Mukerji A. Use of high noninvasive respiratory support pressures in preterm neonates: a single-center experience. J Matern Fetal Neonatal Med 2017; 30 (23) 2838-2843
    CrossrefPubMedSearch in Google Scholar
  • 6 Mukerji A, Wahab MGA, Mitra S. et al. High continuous positive airway pressure in neonates: a physiological study. Pediatr Pulmonol 2019; 54 (07) 1039-1044
    CrossrefPubMedSearch in Google Scholar
  • 7 Gupta AR, Szynal L, Hallinan A, Keszler S. CPAP vs. unsynchronized NIPPV at equal mean airway pressure (MAP). Pediatr Acad Soc 2019; 2851: 442
    PubMedSearch in Google Scholar
  • 8 Buzzella B, Claure N, D'Ugard C, Bancalari E. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants. J Pediatr 2014; 164 (01) 46-51
    Search in Google Scholar
  • 9 Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: Equipment, evidence, and synchronization. Semin Fetal Neonatal Med 2016; 21 (03) 146-153
    CrossrefPubMedSearch in Google Scholar
  • 10 Hadj-Ahmed MA, Samson N, Nadeau C, Boudaa N, Praud JP. Laryngeal muscle activity during nasal high-frequency oscillatory ventilation in nonsedated newborn lambs. Neonatology 2015; 107 (03) 199-205
    CrossrefPubMedSearch in Google Scholar