title: Biphasic Positive Airway Pressure or Continuous Positive Airway Pressure: A Randomized Trial.
abstract: There is currently no clear evidence that nasal-biphasic positive airway pressure (n-BiPAP) confers any advantage over nasal-continuous positive airway pressure (n-CPAP). Our hypothesis was that preterm infants born before 30 weeks' gestation and <2 weeks old when extubated onto n-BiPAP will have a lower risk of extubation failure than infants extubated onto n-CPAP at equivalent mean airway pressure.
  
  
  
  We conducted an unblinded multicenter randomized trial comparing n-CPAP with n-BiPAP in infants born <30 weeks' gestation and <2 weeks old. The primary outcome variable was the rate of extubation failure within 48 hours after the first attempt at extubation. Block randomization stratified by center and gestation (<28 weeks or ≥28 weeks) was performed.
  
  
  
  A total of 540 infants (270 in each group) were eligible to be included in the statistical analysis; 57 (21%) of n-BiPAP group and 55 (20%) of n-CPAP group failed extubation at 48 hours postextubation (adjusted odds ratio 1.01; 95% confidence interval 0.65-1.56; P = .97). Subgroup analysis of infants born before and after 28 weeks' gestation showed no significant differences between the 2 groups. There were no significant differences between arms in death; oxygen requirement at 28 days; oxygen requirement at 36 weeks' corrected gestation; or intraventricular hemorrhage, necrotizing enterocolitis requiring surgery, or pneumothorax.
  
  
  
  This trial shows that there is no added benefit to using n-BIPAP over n-CPAP at equivalent mean airway pressure in preventing extubation failures in infants born before 30 weeks' gestation and <2 weeks old.
authors.affiliation: Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine, Neonatology Center of Excellence, Sidra Medical and Research Center, Doha, Qatar; and suresh.victor@kcl.ac.uk.
authors.forename: Suresh
authors.initials: S
authors.lastname: Victor
authors.affiliation: Centre for Biostatistics, and.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine, College of Health and Social Care, University of Salford, Manchester, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Mitchell
authors.affiliation: Newborn ICU, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, School of Biomedicine.
authors.forename: Huma
authors.initials: H
authors.lastname: Aziz
authors.affiliation: School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom;
authors.forename: Tina
authors.initials: T
authors.lastname: Lavender
mesh_terms: D060666:Airway Extubation / Q000706:statistics & numerical data*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D057194:Intention to Treat Analysis; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D017211:Treatment Failure; D015300:Ventilator Weaning / Q000706:statistics & numerical data*