Abstract
BACKGROUND: Nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), and high-flow nasal cannula (HFNC) are often used after initial extubation in preterm infants. However, data regarding the choice between NCPAP/NIPPV and HFNC are limited. This study examined which therapy was more effective as post-extubation support.
METHODS: This is a retrospective, cohort study that used the Diagnosis Procedure Combination database in Japan, 2011–2021. Propensity score overlap weighting analyses were performed to compare the composite outcomes of in-hospital death and reintubation in preterm infants who received NCPAP/NIPPV and HFNC. We identified infants born at gestational age 22–36 weeks who were intubated within 1 day of birth. We included patients who underwent NCPAP/NIPPV or HFNC after initial extubation. Patients with airway obstruction or congenital airway abnormalities were excluded.
RESULTS: We identified 1,203 preterm infants treated with NCPAP/NIPPV (n=525) or HFNC (n=678). The median (interquartile range) gestational age at delivery was 30 (27–33) weeks, and birth weight was 1296 (884–1,802) g. Compared with the HFNC group, the NCPAP/NIPPV group had a significantly lower proportion of the composite outcome after the overlap weighting analysis (risk ratio, 0.62; 95% confidence interval, 0.47 to 0.83; p=0.001). This significant difference was also observed in infants born at gestational age 22–31 weeks, whereas no significant difference was observed in infants born at gestational age 32–36 weeks.
CONCLUSIONS: NCPAP/NIPPV may be a superior post-extubation support than HFNC in preterm infants, especially in those born at gestational age of 22–31 weeks.
