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Am J Perinatol 2022; 39(12): 1314-1320
DOI: 10.1055/s-0040-1722337
Original Article

Nasal Intermittent Positive Pressure Ventilation versus Continuous Positive Airway Pressure and Apnea of Prematurity: A Systematic Review and Meta-Analysis

Bayane Sabsabi
1   Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Ontario, Canada
,
Ava Harrison
2   Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
,
Laura Banfield
3   Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
,
Amit Mukerji
1   Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations Funding A.M. is supported by a Research Early Career Award from Hamilton Health Sciences Foundation (2019–2021).
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Abstract

Objective The study aimed to systematically review and analyze the impact of nasal intermittent positive pressure ventilation (NIPPV) versus continuous positive airway pressure (CPAP) on apnea of prematurity (AOP) in preterm neonates.

Study Design In this systematic review and meta-analysis, experimental studies enrolling preterm infants comparing NIPPV (synchronized, nonsynchronized, and bi-level) and CPAP (all types) were searched in multiple databases and screened for the assessment of AOP. Primary outcome was AOP frequency per hour (as defined by authors of included studies).

Results Out of 4,980 articles identified, 18 studies were included with eight studies contributing to the primary outcome. All studies had a high risk of bias, with significant heterogeneity in definition and measurement of AOP. There was no difference in AOPs per hour between NIPPV versus CPAP (weighted mean difference = −0.19; 95% confidence interval [CI]: −0.76 to 0.37; eight studies, 456 patients). However, in a post hoc analysis evaluating the presence of any AOP (over varying time periods), the pooled odds ratio (OR) was lower with NIPPV (OR: 0.46; 95% CI: 0.32–0.67; 10 studies, 872 patients).

Conclusion NIPPV was not associated with decrease in AOP frequency, although demonstrated lower odds of developing any AOP. However, definite recommendations cannot be made based on the quality of the published evidence.

Key Points

  • AOP is a common clinical complication related to preterm birth.

  • NIPPV is often used to mitigate AOP and complications.

  • Relative impact of NIPPV and CPAP on AOP remains unclear.

Keywords

continuous positive airway pressure - nasal intermittent positive pressure ventilation - preterm - neonates - noninvasive respiratory support

Supplementary Material



Publication History

Received: 07 July 2020

Accepted: 20 November 2020

Article published online:
15 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Janvier A, Khairy M, Kokkotis A, Cormier C, Messmer D, Barrington KJ. Apnea is associated with neurodevelopmental impairment in very low birth weight infants. J Perinatol 2004; 24 (12) 763-768
    CrossrefPubMedGoogle Scholar
  • 2 Pillekamp F, Hermann C, Keller T, von Gontard A, Kribs A, Roth B. Factors influencing apnea and bradycardia of prematurity - implications for neurodevelopment. Neonatology 2007; 91 (03) 155-161
    CrossrefPubMedGoogle Scholar
  • 3 Martin RJ, Wang K, Köroğlu O, Di Fiore J, Kc P. Intermittent hypoxic episodes in preterm infants: do they matter?. Neonatology 2011; 100 (03) 303-310
    CrossrefPubMedGoogle Scholar
  • 4 Back SA, Han BH, Luo NL. et al. Selective vulnerability of late oligodendrocyte progenitors to hypoxia-ischemia. J Neurosci 2002; 22 (02) 455-463
    CrossrefPubMedGoogle Scholar
  • 5 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    Google Scholar
  • 6 Walsh MC, Morris BH, Wrage LA. et al; National Institutes of Child Health and Human Development Neonatal Research Network. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr 2005; 146 (06) 798-804
    CrossrefPubMedGoogle Scholar
  • 7 Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358 (07) 700-708
    CrossrefPubMedGoogle Scholar
  • 8 Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 2008; 35 (01) 273-281 , x–xi.
    Google Scholar
  • 9 Finer NN, Carlo WA, Walsh MC. et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
    CrossrefPubMedGoogle Scholar
  • 10 Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev 2011; 12 (03) 196-205
    CrossrefPubMedGoogle Scholar
  • 11 Ryan CA, Finer NN, Peters KL. Nasal intermittent positive-pressure ventilation offers no advantages over nasal continuous positive airway pressure in apnea of prematurity. Am J Dis Child 1989; 143 (10) 1196-1198
    PubMedGoogle Scholar
  • 12 Lin CH, Wang ST, Lin YJ, Yeh TF. Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity. Pediatr Pulmonol 1998; 26 (05) 349-353
    CrossrefPubMedGoogle Scholar
  • 13 Lemyre B, Davis PG, de Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for apnea of prematurity. Cochrane Database Syst Rev 2002; (01) CD002272
    PubMedGoogle Scholar
  • 14 Pantalitschka T, Sievers J, Urschitz MS, Herberts T, Reher C, Poets CF. Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2009; 94 (04) F245-F248
    CrossrefPubMedGoogle Scholar
  • 15 Bisceglia M, Belcastro A, Poerio V. et al. A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants. Minerva Pediatr 2007; 59 (02) 91-95
    PubMedGoogle Scholar
  • 16 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
    Google Scholar
  • 17 Higgins JP, Altman DG, Gøtzsche PC. et al; Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    Google Scholar
  • 18 Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. Accessed June 2014 at: https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman
    PubMedGoogle Scholar
  • 19 Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001; 107 (04) 638-641
    Google Scholar
  • 20 Gizzi C, Montecchia F, Panetta V. et al. Is synchronised NIPPV more effective than NIPPV and NCPAP in treating apnoea of prematurity (AOP)? A randomised cross-over trial. Arch Dis Child Fetal Neonatal Ed 2015; 100 (01) F17-F23
    CrossrefPubMedGoogle Scholar
  • 21 Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics 2001; 108 (01) 13-17
    Google Scholar
  • 22 Lampland AL, Plumm B, Worwa C, Meyers P, Mammel MC. Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 2015; 100 (01) F31-F34
    CrossrefPubMedGoogle Scholar
  • 23 Ishihara C, Ibara S, Ohsone Y. et al. Effects of infant flow Bi-NCPAP on apnea of prematurity. Pediatr Int (Roma) 2016; 58 (06) 456-460
    CrossrefPubMedGoogle Scholar
  • 24 Khorana M, Paradeevisut H, Sangtawesin V, Kanjanapatanakul W, Chotigeat U, Ayutthaya JKN. 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 2008; 91 (Suppl. 03) S136-S142
    PubMedGoogle Scholar
  • 25 Moretti C, Giannini L, Fassi C, Gizzi C, Papoff P, Colarizi P. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial. Pediatr Int 2008; 50 (01) 85-91
    Google Scholar
  • 26 O'Brien K, Campbell C, Brown L, Wenger L, Shah V. 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. BMC Pediatr 2012; 12: 43
    CrossrefPubMedGoogle Scholar
  • 27 Salama GSA, Ayyash FF, Al-Rabadi AJ, Alquran ML, Shakkoury AG. Nasal-imv versus nasal-CPAP as an initial mode of respiratory support for premature infants with RDS: a prospective randomized clinical trial. Rawal Med J 2015; 40 (02) 197-202
    PubMedGoogle Scholar
  • 28 Silveira CST, Leonardi KM, Melo APCF, Zaia JE, Brunherotti MAA. Response of preterm infants to 2 noninvasive ventilatory support systems: Nasal CPAP and nasal intermittent positive-pressure ventilation. Respir Care 2015; 60 (12) 1772-1776
    CrossrefPubMedGoogle Scholar
  • 29 Zhou B, Zhai JF, Jiang HX. et al. Usefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome. Eur Rev Med Pharmacol Sci 2015; 19 (04) 573-577
    PubMedGoogle Scholar
  • 30 Farhat AS, Mohammadzadeh A, Saeidi R, Noorizadeh S. A comparison between nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome. Iran J Neonatol 2015; 6 (04) 1-6
    PubMedGoogle Scholar
  • 31 Sadeghnia A, Danaei N, Barkatein B. A comparison of the effect of nasal bi-level positive airway pressure and sigh-positive airway pressure on the treatment of the preterm newborns weighing less than 1500 g affiliated with respiratory distress syndrome. Int J Prev Med 2016; 7: 21
    CrossrefPubMedGoogle Scholar
  • 32 Esmaeilnia T, Nayeri F, Taheritafti R, Shariat M, Moghimpour-Bijani F. Comparison of complications and efficacy of NIPPV and nasal CPAP in preterm infants with RDS. Iran J Pediatr 2016; 26 (02) e2352
    PubMedGoogle Scholar
  • 33 Komatsu DFR, Diniz EMA, Ferraro AA, Ceccon MEJR, Vaz FA. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation. Rev Assoc Med Bras 2016; 62 (06) 568-574
    CrossrefPubMedGoogle Scholar
  • 34 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
    CrossrefPubMedGoogle Scholar
  • 35 Sai Sunil Kishore M, Dutta S, Kumar P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatr 2009; 98 (09) 1412-1415
    CrossrefPubMedGoogle Scholar