Prophylactic nasal intermittent positive pressure ventilation (NIPPV) versus prophylactic nasal continuous positive airway pressure (NCPAP) for preterm infants

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease (CLD), is the most common serious morbidity associated with premature birth, particularly among those infants who have respiratory distress syndrome (RDS) and receive mechanical ventilation after birth. BPD is characterized by lung inflammation and scarring, which are thought to be the effects of excessive (or inadequate) ventilator pressure or volume. Mechanisms of injury that have been explored are barotrauma (lung trauma due to the use of excessive pressure during ventilation), volutrauma (trauma due to the use of excessive ventilation volumes), and atelectotrauma (trauma due to the collapse of alveoli after the use of inadequate ventilation volumes), among others [1]. Various strategies have been developed to avoid the use of mechanical ventilation which would, presumably, limit lung damage and reduce the incidence of BPD. Indeed, nasal continuous positive airway pressure (NCPAP) has been used for decades to treat RDS, and it is a less invasive form of respiratory support that maintains functional residual capacity, improves ventilation‐perfusion mismatch, and minimizes damage to the neonatal lungs. Recently, nasal intermittent positive pressure ventilation (NIPPV), which provides mechanical “sigh” breaths in addition to NCPAP, has been used to treat RDS as well. While it is becoming widely accepted that these gentler forms of ventilation may spare premature infants’ lungs and improve clinical outcomes, it is still unclear whether NCPAP or NIPPV offers a greater reduction in important morbidities of prematurity, most notably BPD. We intend to search the current literature for all randomized, controlled trials and to combine these results for a meta‐analysis for the Neonatal Cochrane Collaboration comparing mortality and BPD, among other important morbidities, in neonates randomized to one of these two methods of respiratory support.