title: Response of Preterm Infants to 2 Noninvasive Ventilatory Support Systems: Nasal CPAP and Nasal Intermittent Positive-Pressure Ventilation.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) in preterm infants is currently applied using intermittent positive pressure (2 positive-pressure levels) or in a conventional manner (one pressure level). However, there are no studies in the literature comparing the chances of failure of these NIV methods. The aim of this study was to evaluate the occurrence of failure of 2 noninvasive ventilatory support systems in preterm neonates over a period of 48 h.
  
  
  METHODS
  A randomized, prospective, clinical study was conducted on 80 newborns (gestational age < 37 weeks, birthweight < 2,500 g). The infants were randomized into 2 groups: 40 infants were treated with nasal CPAP and 40 infants with nasal intermittent positive-pressure ventilation (NIPPV). The occurrence of apnea, progression of respiratory distress, nose bleeding, and agitation was defined as ventilation failure. The need for intubation and re-intubation after failure was also observed.
  
  
  RESULTS
  There were no significant differences in birth characteristics between groups. Ventilatory support failure was observed in 25 (62.5%) newborns treated with nasal CPAP and in 12 (30%) newborns treated with NIPPV, indicating an association between NIV failure and the absence of intermittent positive pressure (odds ratio [OR] 1.22, P < .05). Apnea (32.5%) was the main reason for nasal CPAP failure. After failure, 25% (OR 0.33) of the newborns receiving nasal CPAP and 12.5% (OR 0.14) receiving NIPPV required invasive mechanical ventilation.
  
  
  CONCLUSIONS
  Ventilatory support failure was significantly more frequent when nasal CPAP was used.
authors.affiliation: Pediatrics cstsilveira@gmail.com.
authors.forename: Carmen Salum Thomé
authors.initials: CS
authors.lastname: Silveira
authors.affiliation: Physiotherapy, Hospital Santa Casa de Franca, Franca, São Paulo, Brazil.
authors.forename: Kamila Maia
authors.initials: KM
authors.lastname: Leonardi
authors.affiliation: Physiotherapy, Hospital Santa Casa de Franca, Franca, São Paulo, Brazil.
authors.forename: Ana Paula Carvalho Freire
authors.initials: AP
authors.lastname: Melo
authors.affiliation: Program in Health Promotion, University of Franca, Franca, São Paulo, Brazil.
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: Zaia
authors.affiliation: Program in Health Promotion, University of Franca, Franca, São Paulo, Brazil.
authors.forename: Marisa Afonso Andrade
authors.initials: MA
authors.lastname: Brunherotti
mesh_terms: D001049:Apnea / Q000453:epidemiology / Q000209:etiology; D001724:Birth Weight; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000379:methods; D018450:Disease Progression; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects* / Q000379:methods; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D009666:Nose; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000628:therapy*; D016037:Single-Blind Method; D017211:Treatment Failure
keywords: continuous positive airway pressure; infant; intermittent positive-pressure ventilation; newborn; positive-pressure breathing