698 - Synchronized vs. Non-Synchronized Nasal Intermittent Positive Pressure Ventilation As Initial Respiratory Support in Preterm Infants: A Randomized Study

Publication Number: 4682.698

Emel Okulu, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Yasemin Ezgi Kostekci, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Ferhan Demirtas, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Dogan Kaymaz, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Omer Erdeve, Ankara University School of Medicine, Ankara, Ankara, Turkey; Begum Atasay, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Saadet Arsan, Ankara University, Ankara, Ankara, Turkey

Background: Non-invasive ventilation (NIV) aims to reduce complications of invasive ventilation in preterm infants. Among NIV modes, synchronized nasal intermittent positive pressure ventilation (sNIPPV) may improve respiratory outcomes compared with non-synchronized NIPPV (nsNIPPV) or nCPAP. However, evidence comparing sNIPPV with nsNIPPV as initial respiratory support in preterm infants remains limited.

Objective: To compare synchronized and non-synchronized NIPPV as the initial respiratory support in preterm infants with respiratory distress syndrome (RDS).

Design/Methods: This single-center prospective randomized study was conducted in preterm infants < 32 weeks’ gestation who required NIV were randomized to receive either sNIPPV or nsNIPPV. Infants with major anomalies or lacking parental consent were excluded. Both modes were delivered using Stephanie or Sophie ventilators (Stephan Medizintechnik, Germany) via short nasal prongs; synchronization was achieved with a Graseby capsule. The primary outcome was intubation within the first 3 days of life (DOL). Secondary outcomes included ventilator settings, blood gases, apnea episodes, morbidities, mortality, and hospital stay.

Results: Ninety infants were enrolled (45 sNIPPV, 45 nsNIPPV). Baseline characteristics were similar. Intubation within the first 3 DOL did not differ significantly (20% vs. 29%, p = 0.327). Under comparable mean airway pressure, sNIPPV required lower PEEP and FiO₂ levels (p = 0.019 and p = 0.005). Intubation by 7 DOL was more frequent with nsNIPPV (42% vs. 27%, p = 0.12). Blood gas values, major morbidities (PDA, IVH ≥ grade 3, NEC ≥ stage 2, LOS, BPD, ROP), mortality, and hospital stay were comparable (p > 0.05).

Conclusion(s): This randomized study comparing sNIPPV and nsNIPPV under equivalent ventilator conditions showed that synchronization reduced oxygen and pressure requirements without affecting short-term outcomes. sNIPPV appears to be a feasible and safe initial NIV strategy for preterm infants with RDS.

Table 1
Table 1.pdfCharacteristics of the sNIPPV and nsNIPPV groups