Noninvasive positive pressure ventilation or conventional mechanical ventilation for neonatal continuous positive airway pressure failure.

Background: The aim of this study was to assess the success rate of nasal intermittent positive pressure ventilation (NIPPV) for treatment of continuous positive airway pressure (CPAP) failure and prevention of conventional ventilation (CV) in preterm neonates.

Methods: Since November 2012 to April 2013, a total number of 55 consecutive newborns with gestational ages of 26-35 weeks who had CPAP failure were randomly assigned to one of the two groups. The NIPPV group received NIPPV with the initial peak inspiratory pressure (PIP) of 16-20 cmH2O and frequency of 40-60 breaths/min. The CV group received PIP of 12-20 cmH2O and frequency of 40-60 breaths/min.

Results: About 74% of newborns who received NIPPV for management of CPAP failure responded to NIPPV and did not need intubation and mechanical ventilation. Newborns with lower postnatal age at entry to the study and lower 5 min Apgar score more likely had NIPPV failure. In addition, treatment failure was higher in newborns who needed more frequent doses of surfactant. Duration of oxygen therapy was 9.28 days in CV group and 7.77 days in NIPPV group (P = 0.050). Length of hospital stay in CV group and NIPPV groups were 48.7 and 41.7 days, respectively (P = 0.097).

Conclusions: NIPPV could decrease the need for intubation and mechanical ventilation in preterm infants with CPAP failure.