Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Apr;59(4):1006-1014.
doi: 10.1002/ppul.26879. Epub 2024 Jan 22.

Nasal intermittent positive pressure ventilation during less invasive surfactant administration in preterm infants: An open-label randomized controlled study

Carlo Dani  1   2 , Marcello Napolitano  3 , Ciro Barone  3 , Angelo Manna  3 , Gabriella Nigro  4 , Gianfranco Scarpelli  4 , Elvira Bonanno  4 , Sara Gatto  5 , Francesco Cavigioli  5 , Carlo Forcellini  6 , Enrico Petoello  6 , Renzo Beghini  6 , Martina Ciarcià  1 , Monica Fusco  1 , Fabio Mosca  7   8 , Anna Lavizzari  7 , Eloisa Gitto  9 , Letteria Barbuscia  9 , Pasqua Betta  10 , Carmine Mattia  10 , Luigi Corvaglia  11 , Stefania Vedovato  12 , Giovanni Vento  13 , Gianfranco Maffei  14 , Raffaele Falsaperla  15 , Paola Lago  16 , Luca Boni  17 , Gianluca Lista  5 ; NIPAL Trial Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Nasal intermittent positive pressure ventilation during less invasive surfactant administration in preterm infants: An open-label randomized controlled study

Carlo Dani et al. Pediatr Pulmonol. 2024 Apr.

Abstract

Introduction: Approximately half of very preterm infants with respiratory distress syndrome (RDS) fail treatment with nasal continuous positive airway pressure (NCPAP) and need mechanical ventilation (MV).

Objectives: Our aim with this study was to evaluate if nasal intermittent positive pressure ventilation (NIPPV) during less invasive surfactant treatment (LISA) can improve respiratory outcome compared with NCPAP.

Materials and methods: We carried out an open-label randomized controlled trial at tertiary neonatal intensive care units in which infants with RDS born at 25+0-31+6 weeks of gestation between December 1, 2020 and October 31, 2022 were supported with NCPAP before and after surfactant administration and received NIPPV or NCPAP during LISA. The primary endpoint was the need for a second dose of surfactant or MV in the first 72 h of life. Other endpoints were need and duration of invasive and noninvasive respiratory supports, changes in SpO2/FiO2 ratio after LISA, and adverse effect rate.

Results: We enrolled 101 infants in the NIPPV group and 99 in the NCPAP group. The unadjusted odds ratio for the composite primary outcome was 0.873 (95% confidence interval: 0.456-1.671; p = .681). We found that the SpO2/FiO2 ratio was transiently higher in the LISA plus NIPPV than in the LISA plus NCPAP group, while adverse effects of LISA had similar occurrence in the two arms.

Conclusions: The application of NIPPV or NCPAP during LISA in very preterm infants supported with NCPAP before and after surfactant administration had similar effects on the short-term respiratory outcome and are both safe. Our study does not support the use of NIPPV during LISA.

Keywords: noninvasive ventilation; respiratory distress syndrome.

PubMed Disclaimer

References

REFERENCES

    1. Jobe A. Surfactant for respiratory distress syndrome. NeoReviews. 2014;15(6):e236‐e245.
    1. Hillman N, Jobe AH. Noninvasive strategies for management of respiratory problems in neonates. NeoReviews. 2013;14(5):e227‐e236.
    1. Miedema M, de Jongh FH, Frerichs I, van Veenendaal MB, van Kaam AH. Changes in lung volume and ventilation during surfactant treatment in ventilated preterm infants. Am J Respir Crit Care Med. 2011;184(1):100‐105.
    1. De Luca D, Shankar‐Aguilera S, Bancalari E. LISA/MIST: complex clinical problems almost never have easy solutions. Semin Fetal Neonatal Med. 2021;26(2):101230.
    1. Dargaville PA, Kamlin COF, Orsini F, et al. Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: the OPTIMIST‐A randomized clinical trial. JAMA. 2021;326(24):2478‐2487.

Publication types

MeSH terms

Substances

LinkOut - more resources