A Prospective Observational Pilot Study of Synchronized Nasal Intermittent Positive Pressure Ventilation (SNIPPV) as a Primary Mode of Ventilation in Infants ≥ 28 Weeks with Respiratory Distress Syndrome (RDS)

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Abstract
To compare the outcome of infants with respiratory distress syndrome (RDS) in the neonatal intensive care unit (NICU) who were extubated to synchronized nasal intermittent positive pressure ventilation (SNIPPV) or continued on conventional ventilation (CV), immediately postsurfactant. Prospective observational study of postsurfactant ventilatory management of consecutive infants (born between 10/99 and 12/02) of 28 to 34 weeks gestation. Extubation to SNIPPV was at the attending neonatologists' discretion. Babies in the CV group remained intubated, postsurfactant. There were no significant differences in the maternal demographics, antenatal steroid use, mode of delivery, birth weight (BW), gestational age (GA), gender, Apgar at 5 minutes, age at surfactant instillation, or oxygenation index (OI) prior to surfactant administration, between infants continued on CV (n=35) and those extubated to SNIPPV (n=24). The total duration of endotracheal intubation (mean+/-SEM; CV versus SNIPPV; 2.4+/-0.4 versus 0.3+/-0.0 days, p=0.001) and duration of supplemental oxygen exposure (15+/-3.2 versus 8.2+/-3.3 days, p=0.04) were significantly shorter in the SNIPPV group. Furthermore, the duration of parenteral nutrition (12.1+/-1.6 versus 8.4+/-0.8 days, p=0.02) and length of stay (37.5+/-3.0 versus 29.1+/-3.3 days, p=0.04) were also significantly shorter in the SNIPPV group. There were no differences between the two groups in blood gas or OI values postsurfactant (up to 48 hours). There was no statistical difference in the incidence of intraventricular hemorrhage grade I (three (9%) in the CV group and two infants (8%) in the SNIPPV group). No infant died in either group or had patent ductus arteriosus, air leaks, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia. Infants of 28 to 34 weeks GA with RDS requiring surfactant with early extubation to SNIPPV had a shorter duration of intubation, and decreased need for oxygen as compared to CV. There was also a significant decrease in the duration of parenteral nutrition and hospitalization. SNIPPV is a safe and effective primary mode of ventilation in larger premature infants.