Background: Non-invasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP) are non-invasive respiratory supports commonly used in preterm infants. There are conflicting data on the superiority between these two modes of non-invasive respiratory support.
Objective: The objective of this study was to determine if oxygen saturation is more within the target range on NIPPV compared to CPAP using the data from histograms.
Methods: Retrospective analysis of premature neonates (birth weight <1500 grams, gestational age <30 weeks) admitted to the NICU between 11/2014 and 05/2020, for which oxygen saturation histogram data was available one day before and after the transition between NIPPV and CPAP. FiO2 at the time of data collection was greater than 30 percent. This histogram data, the percentage of time spent in certain SpO2 ranges, was compared before and after the de-escalation from NIPPV to CPAP or escalation from CPAP to NIPPV. FiO2 and PEEP/MAP were additionally compared between the two modes of respiratory support.
Results: A total of 12 infants met inclusion criteria. Among the 12 infants, there were 14 episodes of transition between NIPPV and CPAP, 6 switches from NIPPV to CPAP and 8 from CPAP to NIPPV. The percentage of time that oxygen saturation was within the target range (89-94 %) was similar on two modes of respiratory support (42.9% vs. 42.9%, p=0.9). No statistically significant difference was found between other oxygen saturation ranges before and after the changes of respiratory support. Similarly, there was no difference in oxygen saturation ranges in two modes when infants switched from CPAP to NIPPV and NIPPV to CPAP. The calculated mean airway pressure on NIPPV was significantly higher than the PEEP on CPAP (p < 0.001) and there was a trend towards lower FiO2 on NIPPV compared to CPAP.
Conclusion: Oxygen saturation ranges on histogram were similar in premature infants when supported on CPAP and NIPPV. NIPPV is not superior to CPAP in maintaining oxygen saturation within the target range in premature infants on moderate non-invasive respiratory support.
