Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes.

Abstract

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. To compare the outcomes of infants managed with SNIPPV (postextubation or for apnea) to infants not treated with SNIPPV at 2 sites. 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. 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). 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.