title: A comparison of bilevel and ventilator-delivered non-invasive respiratory support.
abstract: OBJECTIVE
  To compare the rates of death or bronchopulmonary dysplasia (BPD) in infants who received nasal intermittent positive pressure ventilation (NIPPV) delivered by a conventional mechanical ventilator (CMV) or a bilevel device.
  
  
  METHODS
  A preplanned non-randomised comparison of infants randomised to the NIPPV arm of the NIPPV trial.
  
  
  METHODS
  Thirty-six tertiary neonatal units in three continents.
  
  
  METHODS
  Infants <1000 g and <30 weeks gestational age at birth.
  
  
  METHODS
  Infants received treatment with CMV NIPPV or bilevel NIPPV, as a primary mode of respiratory support or following first extubation.
  
  
  RESULTS
  241 received mainly bilevel NIPPV and 215 mainly CMV NIPPV. No difference was found in death or BPD at 36 weeks corrected age (adjusted OR 0.88 (95% CI 0.57 to 1.35)). More deaths occurred in infants receiving bilevel NIPPV (9.4%) than in CMV NIPPV (2.3%) (adjusted OR 5.01: 95% CI 1.74 to 14.4). There was a corresponding but not statistically significant decrease in BPD in the bilevel NIPPV group (30% vs 37%) (adjusted OR 0.64 (95% CI 0.41 to 1.02)). No difference was observed in extubation failure or age at last extubation. A post hoc test of interaction between device type and synchronisation was not statistically significant.
  
  
  CONCLUSIONS
  We did not observe a statistically significant difference in the composite outcome of death or BPD between infants who received mostly bilevel NIPPV compared with mostly CMV NIPPV. Differences in component outcomes of morbidity and BPD may be due to the competing nature of these outcomes or differences in baseline characteristics of infants.
  
  
  BACKGROUND
  NCT00433212.
authors.affiliation: Department of Neonatology, Royal Maternity Hospital, Belfast, UK.
authors.forename: David
authors.initials: D
authors.lastname: Millar
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Canada.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lemyre
authors.affiliation: Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, USA Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Haresh
authors.initials: H
authors.lastname: Kirpalani
authors.affiliation: Department of Pediatrics, University of Manitoba, Winnipeg, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Chiu
authors.affiliation: Departments of Neonatology and Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Robin S
authors.initials: RS
authors.lastname: Roberts
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*