NIPPV Outperforms NCPAP in Premature Infant Lung Care

TOPLINE:

Nasal intermittent positive pressure ventilation (NIPPV) reduced the risk of requiring invasive ventilation and developing bronchopulmonary dysplasia by nearly half compared with nasal continuous positive airway pressure (NCPAP) in premature infants with respiratory distress syndrome.

METHODOLOGY: 

• Researchers conducted an updated meta-analysis of 14 randomized trials involving 1755 premature infants (< 37 weeks’ gestation) with respiratory distress syndrome to compare NIPPV with NCPAP as their initial respiratory support.
• Data were gathered through systematic searches of Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1980 and February 2022.
• Primary outcomes were the incidence of invasive ventilation and bronchopulmonary dysplasia. Subgroup analyses were stratified by — infants who received surfactant treatment, gestational age (> 30 or ≤ 30 weeks), and birth weight (> or ≤ 1500 g).
• Secondary outcomes included mortality, pulmonary air leaks, retinopathy of prematurity stage ≥ 2, necrotizing enterocolitis Bell stage ≥ 2, and intraventricular hemorrhage grade ≥ 3.

TAKEAWAY:

• NIPPV demonstrated superior efficacy with a 47% reduction in the incidence of invasive ventilation requirement (relative risk [RR], 0.53; P < .001) and a 49% reduction in the incidence of bronchopulmonary dysplasia (RR, 0.48; P = .004) compared with NCPAP.
• Benefits of NIPPV on invasive ventilation incidence persisted across subgroups defined by gestational age, birth weight, and surfactant treatment. However, reductions in bronchopulmonary dysplasia were significant only when stratified by gestational age.
• Secondary outcomes showed no significant differences between groups. No increase in pneumothorax was observed with NIPPV.

IN PRACTICE:

“While these findings are promising, higher-quality randomized controlled trials with standardized protocols are needed before definitive clinical recommendations can be established,” the authors of the study wrote.

SOURCE:

This study was led by Juan Zeng, Southwest Hospital of Army Medical University, and Rong Tan, Jiulongpo People’s Hospital, both in Chongqing, China. It was published online on June 28, 2025, in the European Journal of Pediatrics.

LIMITATIONS:

Although synchronized NIPPV may offer advantages over nonsynchronized NIPPV, insufficient data prevented subgroup comparisons of the two modes. As most trials enrolled infants with gestational age > 30 weeks, the findings may not be generalizable to extremely premature neonates. Finally, the overall low methodological quality and limited number of robust, high-quality studies reduce confidence in these conclusions.

DISCLOSURES:

The authors declared that they did not receive any funds, grants, or other support. They declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.