Outcomes of continuous and non-invasive positive pressure ventilation in neonates

Objective: To compare the clinical outcomes of non-invasive nasal intermittent positive pressure ventilation (NIPPV) with nasal continuous positive airway pressure (NCPAP) in preterm neonates following extubation.Study design: Descriptive, analytical study. Place and Duration of the Study: Department of Paediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan, from October 2023 to March 2024.Methodology: Preterm neonates born between 27 and 36+6 weeks of gestation who required mechanical ventilation at birth and were subsequently extubated to either NCPAP or NIPPV were enrolled in the study. A total of 95 neonates were included: 49 received NCPAP, and 46 received NIPPV. Outcomes were measured over the first week post-extubation.Results: The median gestational age was comparable between the groups [NCPAP: 32 weeks (IQR 30-35), NIPPV: 32.2 weeks (IQR 30-35)]. Extubation failure occurred significantly more frequently in the NCPAP group (55.1%) compared with the NIPPV group (8.7%, p < 0.001). Neonates in the NCPAP group required longer durations of mechanical ventilation, non-invasive support, and hospital stay. In multivariate analysis, NCPAP was independently associated with higher odds of extubation failure (OR 6.61, 95% CI: 1.53-28.62; p = 0.01). Mortality rate was low and similar across both groups.Conclusion: NIPPV was associated with a substantially lower risk of extubation failure and shorter recovery time compared with NCPAP. These findings suggest that NIPPV may be considered a preferred mode of post-extubation support in preterm neonates.