Increased non-invasive ventilatory support use in the first week of life for extremely preterm infants: a national cohort study

Background: Use of non-invasive ventilation (NIV) in neonatal units is associated with reduced rates of bronchopulmonary dysplasia and has been widely adopted. Trials provide evidence for use in infants born over 30 weeks gestational age (GA), but anecdotally NIV is being used in earlier gestations. We characterised recent changes in practice and evaluated outcomes for these infants further to the trends published by Sand et al.

Methods: Using data from the National Neonatal Research Database (NNRD) for all infants born under 30 weeks GA in England and Wales over a 6-year period, we assessed respiratory support trajectories in the delivery room and neonatal unit. Data was analysed in Stata statistical software [1] [2] [3] [4] [5].

Results: We analysed data from all live-born infants under 30/40 between 1st January 2016 and 31st December 2021. 24,017 babies were included. We demonstrate increased use of continuous positive airway pressure (CPAP; 17.3 to 28.8%) and the introduction of high-flow nasal cannulae (HFNC) as the highest method of respiratory support in the delivery room. CPAP use increased in both extremely preterm (under 28 weeks GA; 7.2 to 17.5%) and most preterm (under 25 weeks GA; 0.7 to 4.8%) cohorts. We report difference in failure rates (need for mechanical ventilation in the first 7 days of life) of NIV as primary respiratory support between the two GA groups (60.3% extremely preterm compared to 48.6% under 30/40).

Conclusions: Use of NIV in the UK is expanding. There is need for evidence-based guidelines for NIV in extremely preterm infants and explore ways to further improve NIV uptake.

Publication History

Article published online:
19 May 2025

• Literatur

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