TOP 37 - Evaluation of High Nasal Continuous Positive Airway Pressure (nCPAP) and Synchronized Nasal Intermittent Positive Pressure Ventilation (sNIPPV) in Preterm Infants

Publication Number: 1797.TOP 37

Ferhan Demirtas, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Doğan Kaymaz, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Ceren Evcen, Ankara Univeristy Faculty Of Medicine, Ankara, Ankara, Turkey; Ezgi Köstekci, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Emel Okulu, Ankara University, Ankara, Ankara, Turkey; Omer Erdeve, Ankara University School of Medicine, Ankara, NY, United States; Begüm Atasay, Ankara University Faculty of Medicine, Ankara, Ankara, Turkey; Saadet Arsan, Ankara University, Ankara, Ankara, Turkey

Background: Prolonged invasive mechanical ventilation is a major contributor to bronchopulmonary dysplasia (BPD) in preterm infants; thus, early extubation and noninvasive respiratory support strategies such as nasal continuous positive airway pressure (nCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are preferred. Systematic reviews indicate that NIPPV, compared to nCPAP, reduces respiratory failure, reintubation, and BPD incidence. The benefit of NIPPV may be due to higher mean airway pressure (MAP), improving alveolar recruitment and gas exchange. High-pressure nCPAP can achieve similar MAP levels and potentially provide comparable efficacy. Evidence suggests high nCPAP enhances extubation success without increasing adverse events and may be non-inferior to NIPPV. However, despite its potential advantages, no studies have directly compared high nCPAP with synchronized NIPPV (sNIPPV) under equivalent MAP conditions to date. This study aims to determine whether high nCPAP is as effective as sNIPPV for post-exubation support in preterm infants.

Objective: To compare reintubation rates within 72 hours and 7 days after planned extubation among preterm infants supported by high nCPAP or sNIPPV. Secondary objectives include comparing respiratory and oxygen support duration, prematurity-related morbidities, hospital stay, and mortality.

Design/Methods: This single-center, prospective-retrospective study includes preterm infants born < 32 weeks of gestation and admitted to the Neonatal Intensive Care Unit (NICU). Eligible infants were those who received invasive mechanical ventilation within the first 3 days of life and were planned for their first extubation within the first 14 days. Prospective data collection began on April 1, 2025, and continued for eight months; historical control data from previous infants were collected and will be used for comparison. Infants in the study will receive high nCPAP (8–12 cmH₂O) immediately after extubation, with PEEP set equal to or 1–3 cmH₂O higher than the MAP used during invasive ventilation. The control group will include matched historical infants extubated to sNIPPV with similar MAP. Noninvasive respiratory support was provided via short binasal prongs with continuous monitoring of oxygen saturation and transcutaneous CO₂ levels. Data collected will include antenatal, perinatal, respiratory, and outcome variables.