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Role of noninvasive positive pressure ventilation in prevention of bronchopulmonary dysplasia in extreme preterm neonates

Presented at the Neonatal Society 2018 Spring Meeting.

Sharma VK, Pejaver R, Banu N, Sharma A

Neonatal Unit, Princess Anne hospital, University Hospital, Southampton, UK

Background: Bronchopulmonary dysplasia (BPD) is the leading cause of mortality and morbidity in extremely preterm neonates. Mechanical ventilation associated lung injury and inflammation is one of the key factors leading to BPD (1). Noninvasive positive pressure ventilation (NIPPV) can be used to provide respiratory support and prevent extubation failure (2,3). We hypothesised that it may reduce the incidence of BPD.

Methods: This work was performed as a retrospective cohort study for all neonates born in 2016. A structured proforma was used to collect anonymised epidemiological and clinical data from the case records of neonates in 2 cohorts (pre NIPPV vs post NIPPV). BPD was defined as need of supplemental oxygen or respiratory support at 36 weeks post menstrual age. The primary objective assessed the impact of NIPPV on the incidence of BPD in neonates less than 30 weeks gestation in both the cohorts. The secondary objective was to analyse extubation failure rates, duration of invasive ventilation and hospitalization. This study was performed as a service evaluation hence funding and ethical approval were not required.

Results: 75 babies were included in the study. Cohort 1 (pre NIPPV n=31) and Cohort 2 (post NIPPV n=44) were similar in terms of gestational age, birth weight, antenatal steroid use and initial respiratory management at birth. There was a significant reduction in incidence of BPD (74.2% vs 43.2% [RR 1.71 (1.15-2.55): P=0.008] between Cohort 1 & 2. The extubation failure rate for NIPPV was 26.5%. In babies with gestational age 26 weeks and below, the incidence of BPD decreased from 91.6% to 75%. While in babies with 27 weeks and above, BPD decreased from 63.1% to 16.7%. The two cohorts were similar in incidence of common co-morbidities like PDA, severe ROP, NEC, IVH and death. Reducing trends were seen in the use of postnatal steroids and PDA ligation in Cohort 2. Mean duration of mechanical ventilation was 209 hours in cohort 2 compared to 298 hours in cohort 1. Babies in Cohort 2 had a higher likelihood of going home without oxygen and at an early gestational age.

Conclusion: NIPPV can be successfully used to reduce invasive ventilation and manage extubation failure in extreme preterm neonates. This study demonstrates that the incidence of BPD may be reduced by NIPPV as a mode of respiratory support without increasing comorbidities in neonates under 30 weeks of gestation.

Corresponding author: drvarun1983@gmail.com

References
1. Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS; NIPPV Study Group. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med. 2013 Aug 15;369(7):611-20
2. Ramos-Navarro C, Sanchez-Luna M, Sanz-López E, Maderuelo-Rodriguez E, Zamora-Flores E. Effectiveness of Synchronized Noninvasive Ventilation to Prevent Intubation in Preterm Infants. AJP Rep. 2016 Jul;6(3): e264-71
3. Lemyre B, Davis PG, De Paoli AG, Kirpalani H. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev. 2014 Sep 4;(9)

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