Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes.
BACKGROUND
Synchronized nasal intermittent positive-pressure ventilation (SNIPPV) use reduces reintubation rates compared with nasal continuous positive airway pressure (NCPAP). Limited information is available on the outcomes of infants managed with SNIPPV.


OBJECTIVE
To compare the outcomes of infants managed with SNIPPV (postextubation or for apnea) to infants not treated with SNIPPV at 2 sites.


METHODS
Clinical retrospective data was used to evaluate the use of SNIPPV in infants <or=1250 g birth weight (BW); and 3 BW subgroups (500-750, 751-1000, and 1001-1250 g, decided a priori). SNIPPV was not assigned randomly. Bronchopulmonary dysplasia (BPD) was defined as treatment with supplemental oxygen at 36 weeks' postmenstrual age.


RESULTS
Overall, infants who were treated with SNIPPV had significantly lower mean BW (863 vs 964 g) and gestational age (26.4 vs 27.9 weeks), more frequently received surfactant (85% vs 68%), and had a higher incidence of BPD or death (39% vs 27%) (all P < .01) compared with infants treated with NCPAP. In the subgroup analysis, SNIPPV was associated with lower rates of BPD (43% vs 67%; P = .03) and BPD/death (51% vs 76%; P = .02) in the 500- to 750-g infants, with no significant differences in the other BW groups. Logistic regression analysis, adjusting for significant covariates, revealed infants with 500-700-g BW who received SNIPPV were significantly less likely to have the outcomes of BPD (OR: 0.29 [95% CI: 0.11-0.77]; P = .01), BPD/death (OR: 0.30 [95% CI: 0.11-0.79]; P = .01), neurodevelopmental impairment (NDI) (OR: 0.29 [95% CI: 0.09-0.94]; P = .04), and NDI/death (OR: 0.18 [95% CI: 0.05-0.62]; P = .006).


CONCLUSIONS
SNIPPV use in infants at greatest risk of BPD or death (500-750 g) was associated with decreased BPD, BPD/death, NDI, and NDI/death when compared with infants managed with NCPAP.
Bhandari
Vineet
V
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. vineet.bhandari@yale.edu
Finer
Neil N
NN
Ehrenkranz
Richard A
RA
Saha
Shampa
S
Das
Abhik
A
Walsh
Michele C
MC
Engle
William A
WA
VanMeurs
Krisa P
KP
D001724:Birth Weight; D001925:Brain Damage, Chronic / Q000401:mortality / Q000517:prevention & control; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005865:Gestational Age; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation / Q000379:methods*; D010102:Oxygen Inhalation Therapy; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D015300:Ventilator Weaning