Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Evaluation of three non-invasive ventilation modes after extubation in the treatment of preterm infants with severe respiratory distress syndrome

Journal of Perinatology volume 42, pages 1238–1243 (2022)Cite this article

Subjects

Abstract

Objective

To evaluate the efficacy and safety of three different modes of non-invasive post-extubation ventilation support in preterm infants with severe respiratory distress syndrome (RDS).

Methods

Infants diagnosed with severe RDS after extubation were randomized to receive nasal continuous positive airway pressure ventilation (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), and non-invasive high-frequency oscillatory ventilation (NHFO). The clinical outcomes and complications of infants in different groups were recorded.

Results

In infants less than 32 weeks, NCPAP had a significant increase in extubation failure when compared with NIPPV and NHFO, and the gastrointestinal feeding time, the numbers of apnea, and hospitalization costs in the NCPAP group were significantly higher. The incidence of complications was also higher in the NCPAP group. There was no difference in clinical outcomes and complications in infants greater than 32 weeks.

Conclusion

For infants with severe RDS less than 32 weeks after extubation, NIPPV and NHFO are more cost-effective in comparison to NCPAP.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The datasets used during the present study are available from the corresponding author upon reasonable request.

References

  1. Permall DL, Pasha AB, Chen XQ. Current insights in non-invasive ventilation for the treatment of neonatal respiratory disease. Ital J Pediatr. 2019;45:105.

    Article  Google Scholar 

  2. Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, et al. Respiratory care for the ventilated neonate. Can Respir J. 2018;2018:7472964.

    Article  Google Scholar 

  3. Azevedo A, Flor-de-Lima F, Rocha G, Rodrigues C, Guimarães H. Impact of changes in perinatal care on bronchopulmonary dysplasia: an overview of the last two decades. J Pediatr Neonat Individ Med. 2017;6:e060208.

    Google Scholar 

  4. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the management of respiratory distress syndrome – 2019 update. Neonatology. 2019;115:432–50.

    Article  Google Scholar 

  5. Behnke J, Lemyre B, Czernik C, Zimmer KP, Ehrhardt H, Waitz M. Non-invasive ventilation in neonatology. Dtsch Arztebl Int. 2019;116:177–83.

    PubMed  PubMed Central  Google Scholar 

  6. Foglia EE, Ades A, Napolitano N, Lefelman J, Nadkarni V, Nishisaki A. Factors associated with adverse events during tracheal intubation in the NICU. Neonatology. 2015;108:23–29.

    Article  Google Scholar 

  7. Cummings JJ, Polin RA, Committee on Fetus and Newborn, American Academy of Pediatrics. Noninvasive respiratory support. Pediatrics. 2016;137:e20153758

    Article  Google Scholar 

  8. Moniz M, Silvestre C, Nunes P, Abadesso C, Matias E, Loureiro H, et al. High-frequency oscillatory ventilation in children: a 10-year experience. J Pediatr (Rio J). 2013;89:48–55.

    Article  Google Scholar 

  9. Carvalho CG, Silveira RC, Procianoy RS. Ventilator-induced lung injury in preterm infants. Rev Bras Ter Intensiv. 2013;25:319–26.

    Google Scholar 

  10. Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol. 2016;33:318–28.

    Article  Google Scholar 

  11. Thébaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. Bronchopulmonary dysplasia. Nat Rev Dis Prim. 2019;5:78.

    Article  Google Scholar 

  12. Williams E, Greenough A. Respiratory support of infants with congenital diaphragmatic hernia. Front Pediatr. 2021;24:9–808317.

    Google Scholar 

  13. Zhu XW, Shi Y, Shi LP, Liu L, Xue J, Ramanathan R, NHFOV Study Group. Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: study protocol for a multi-center prospective randomized controlled trial. Trials. 2018;19:319.

    Article  Google Scholar 

  14. Isayama T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA. 2016;316:611–24.

    Article  Google Scholar 

  15. Goldbart AD, Gozal D. Non-invasive ventilation in preterm infants. Pediatr Pulmonol Suppl. 2004;26:158–61.

    Article  Google Scholar 

  16. Ekhaguere O, Patel S, Kirpalani H. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure before and after invasive ventilatory support. Clin Perinatol. 2019;46:517–36.

    Article  Google Scholar 

  17. Chen C-Y, Chou A-K, Chen Y-L, Chou H-C, Tsao P-N, Hsieh W-S. Quality improvement of nasal continuous positive airway pressure therapy in neonatal intensive care unit. Pediatr Neonatol. 2017;58:229–35.

    Article  Google Scholar 

  18. Friedman CA, Menchaca RC, Baker MC, Rivas CK, Laberge RN, Rios EH, et al. Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations. Respir Care. 2013;58:1134–42.

    Article  Google Scholar 

  19. Verder H, Bohlin K, Kamper J, Lindwall R, Jonsson B. Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia. Acta Pediatr. 2009;98:1400–8.

    Article  Google Scholar 

  20. DeMauro SB, Millar D, Kirpalani H. Noninvasive respiratory support for neonates. Curr Opin Pediatr. 2014;26:157–62.

    Article  Google Scholar 

  21. Alexiou S, Panitch HB. Physiology of non-invasive respiratory support. Semin Fetal Neonatal Med. 2016;21:174–80.

    Article  Google Scholar 

  22. Mazmanyan P, Mellor K, Dore CJ, Modi N. A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting. Arch Dis Child Fetal Neonatal Ed. 2016;101:F16–20.

    Article  CAS  Google Scholar 

  23. Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: equipment, evidence, and synchronization. Semin Fetal Neonatal Med. 2016;21:146–53.

    Article  Google Scholar 

  24. Dumpa V, Katz K, Northrup V, Bhandari V. SNIPPV vs NIPPV: does synchronizafion matter? J Perinatol. 2012;32:438–42.

    Article  CAS  Google Scholar 

  25. Owen LS, Morley CJ, Dawson JA, Davis PG. Effects of non-synchronised nasal intermittent positive pressure ventilation on spontaneous breathing in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2011;96:422–8.

    Article  Google Scholar 

  26. Meneses J, Bhandari V, Alves JG, Herrmann D. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatries. 2011;127:300–7.

  27. Ullrich TL, Czernik C, Buhrer C, Schmalisch G, Fischer HS. Nasal high-frequency oscillatory ventilation impairs heated humidification: a neonatal bench study. Pediatr Pulmonol. 2017;52:1455–60.

    Article  Google Scholar 

  28. Fischer HS, Bohlin K, Buhrer C, Schmalisch G, Cremer M, Reiss I, et al. Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries. Eur J Pediatr. 2015;174:465–71.

    Article  Google Scholar 

  29. Mukerji A, Singh B, Helou SE, Fusch C, Dunn M, Belik J, et al. Use of noninvasive high-frequency ventilation in the neonatal intensive care unit: a retrospective review. Am J Perinatol. 2015;30:171–6.

    Article  Google Scholar 

  30. Kugelman A, Durand M. A comprehensive approach to the prevention of bronehopulmonary dysplasia. Pediatr Pulmonol. 2011;46:1153–65.

    Article  Google Scholar 

  31. Hossein A, Ghafari V, Nakhshab M. Nasal intermittent mandatory ventilation (NIMV) versus nasal continuous positive airway pressure (nCPAP) in weaning from mechanical ventilation in preterm infants. J Mazand Univ Med Sci. 2011;84:113–20.

  32. Wang CH, Shi LP, Ma XL, Lin HJ, Xu YP, Du LZ. [Use of noninvasive high-frequency oscillatory ventilation in very low birth weight infants]. Zhonghua Er Ke Za Zhi. 2017;55:177–81.

    CAS  PubMed  Google Scholar 

  33. Malakian A, Bashirnezhadkhabaz S, Aramesh MR, Dehdashtian M. Noninvasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med. 2020;33:2601–7.

    Article  Google Scholar 

  34. Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev. 2003;2:CD000143.

    Google Scholar 

  35. 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;164:46–51.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally: Gaole Yuan, Hailan Liu.

Authors and Affiliations

  1. Department of Pediatrics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China

    Gaole Yuan, Zhihong Wu & Xiao Chen

  2. Department of Ultrasound, The First Hospital of Nanchang, Nanchang, Jiangxi Province, China

    Hailan Liu

Authors
  1. Gaole Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hailan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhihong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GY is the guarantor of the entire study. GY designed this study and defined the intellectual content. HL and ZW did the clinical research and collected the data. GY, HL, and XC analyzed the data. XC did the literature research. GY drafted and revised the paper. All authors have read and approved the final paper.

Corresponding author

Correspondence to Gaole Yuan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University and the guardians of all newborns read and signed the informed consent.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yuan, G., Liu, H., Wu, Z. et al. Evaluation of three non-invasive ventilation modes after extubation in the treatment of preterm infants with severe respiratory distress syndrome. J Perinatol 42, 1238–1243 (2022). https://doi.org/10.1038/s41372-022-01461-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01461-y

This article is cited by

Search

Advanced search

Quick links