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Pediatrics. 2009 Aug;124(2):517-26. doi: 10.1542/peds.2008-1302. Epub 2009 Jul 27.

Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes.

Collaborators (134)

Jobe A, Oh W, Laptook AR, Vohr BR, Hensman A, Noel L, Stephens B, Watson VE, Leach TM, Walsh MC, Fanaroff AA, Wilson-Costello D, Newman NS, Siner BS, Neuhauser D, Goldberg RN, Cotten CM, Goldstein R, Auten K, Lohmeyer M, Stoll BJ, Adams-Chapman I, Buchter S, Hale E, Bishop M, Seabrook I, Lemons JA, Poindexter BB, Dusick AM, Engle WA, Appel DD, Herron D, Miller L, Richard L, Hooper R, Wright LL, Higgins RD, McClure EM, Poole WK, Das A, Hastings B, McClure E, Newman J, Perritt RL, Yao Q, Huitema CP, Zaterka-Baxter K, Stevenson DK, Van Meurs KP, Hintz SR, Rhine WD, Ball MB, Kibler C, Parker JR, Baran JM, Carlo WA, Namasivayam A, Peralta-Carcelen M, Collins MV, Cosby SS, Phillips V, Finer NN, Vaucher YE, Rasmussen MR, Wozniak PR, Heldt G, Arnell K, Demetrio C, Fuller MG, Henderson C, Rich W, Grabarczyk M, Joseph C, Bridge R, Goodmar J, Donovan F, Schibler K, Steichen J, Alexander B, Grisby C, Mersmann M, Mincey H, Shively J, Gratton T, Bauer CR, Duara S, Everett R, Eguaras SF, Fajardo-Hiriart S, Phelps DL, Sinkin RA, Myers G, Reubens L, Hust D, Jensen R, Laptook AR, Salhab WA, Rosenfeld CR, Heyne RJ, Hickman JF, Hensley G, Miller NA, Morgan J, Martin M, Allen J, Tyson JE, Kennedy K, Morris BH, Bradt PJ, Whiteley LL, Akpa EG, Cluff PA, Lis AE, McDavid GE, Alaniz NI, Tate PL, O'Shea TM, Dillard RG, Washburn L, Peters N, Jackson B, Shankaran S, Johnson Y, Pappas A, Bara R, Muran G, Kennedy D, Kazzi SN, Hart KH, Betts M, Ehrenkranz RA, Gettner P, Konstantino M, Romano E.

Author information

  • 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. vineet.bhandari@yale.edu

Abstract

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.

OBJECTIVES:

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).

CONCLUSION:

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.

Comment in

PMID:
19651577
[PubMed - indexed for MEDLINE]
PMCID:
PMC2924622
Free PMC Article

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