Am J Perinatol 2017; 34(12): 1190-1198
DOI: 10.1055/s-0037-1602141
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Noninvasive Ventilation in Newborns ≤ 1,500 g after Tracheal Extubation: Randomized Clinical Trial

Simone Nascimento Santos Ribeiro
1   Section of Physiotherapy, Hospital Sofia Feldman, Belo Horizonte, MG, Brazil
,
Maria Jussara Fernandes Fontes
2   Department of Medicine, Federal University Minas Gerais, Belo Horizonte, MG, Brazil
,
Vineet Bhandari
3   Section of Neonatology, St. Christopher's Hospital for Children/Drexel University, Philadelphia, Pennsylvania
,
Camilla Borges Resende
4   Respiratory Care, Belo Horizonte, MG, Brazil
,
Cintia Johnston
5   Respiratory Care, Department of Pediatrics, Federal University São Paulo, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

23 January 2017

11 March 2017

Publication Date:
18 April 2017 (online)

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Abstract

Objective Our aim was to compare the success of extubation in neonates managed with nonsynchronized intermittent nasal positive-pressure ventilation (nsNIPPV) and two modes of nasal continuous positive airway pressure (NCPAP) after the first extubation.

Study Design Randomized controlled clinical trial conducted in the neonatal intensive care unit (NICU) included infants with gestational age ≤ 34 weeks and birth weights (BW) 500 to 1,500 g with a diagnosis of respiratory distress syndrome (RDS), divided into three groups: ventilation with nsNIPPV, bubble-NCPAP, and ventilator-NCPAP. Extubation failure (EF) was defined as occurring within 48 hours after extubation.

Results We included 101 newborns: nsNIPPV (n = 36); bubble-NCPAP (n = 32) ventilator-NCPAP (n = 33). Overall, the extubation success rate was 81.2%. There were no skin, gastric, or pulmonary complications related to noninvasive ventilation (NIV) (p = 1). There was no difference between the groups regarding the success/EF (p = 0.4). There was extubation success in 81 (81.2%) cases, and EF occurred in 20 (19.8%), associated with longer invasive mechanical ventilation time (p < 0.001) and development of bronchopulmonary dysplasia (p = 0.04).

Conclusion In this trial, three modalities of NIV applied in the success/failure outcomes of extubation avoided reintubation in 80% of infants.