OBJECTIVES: To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants. METHODS: China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO₂) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). RESULTS: A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO₂ at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05). CONCLUSIONS Compared with NIPPV, NHFOV can effectively remove CO₂ and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.
Infant ; Infant, Newborn ; Humans ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Airway Extubation ; Noninvasive Ventilation ; Bronchopulmonary Dysplasia ; High-Frequency Ventilation ; Respiratory Distress Syndrome, Newborn/therapy* ; Continuous Positive Airway Pressure

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.
High-Frequency Ventilation ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; Intermittent Positive-Pressure Ventilation ; Respiratory Distress Syndrome, Newborn

OBJECTIVE: To systematically evaluate the clinical efficacy of nasal high-frequency ventilation (nHFV) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS: A literature search was performed in PubMed, Cochrane Library, EMBase (Ovid), Chinese Biomedical Literature Database, Chinese Journal Full-text Database, Wanfang Data, and Weipu Data to collect the randomized controlled trials (RCTs) that compared the clinical efficacy of nHFV and nasal continuous positive airway pressure (nCPAP) in the treatment of NRDS. A Meta analysis was performed on the included RCTs using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane 5.1.0. RESULTS: A total of 4 RCTs involving 218 patients were included. The Meta analysis showed that compared with the nCPAP group, the nHFV group had a significantly better treatment outcome (RR=1.73, 95%CI: 1.39-2.15, P<0.00001). There were no significant differences in the incidence rates of intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis, pneumothorax and retinopathy of prematurity. CONCLUSIONS Compared with nCPAP, nHFV has better clinical efficacy in the treatment of NRDS, without increasing the risk of related complications.
High-Frequency Ventilation ; Humans ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Respiratory Distress Syndrome, Newborn ; Treatment Outcome

Nasal intermittent positive pressure ventilation (NIPPV) can augment nasal continuous positive airway pressure (nCPAP) by delivering intermittent positive pressure ventilation in a noninvasive way and can provide a new option for neonatal noninvasive respiratory support. NIPPV has an advantage over nCPAP in primary and post-extubation respiratory support. Moreover, it can reduce severe apnea of prematurity. Synchronized NIPPV has promising application prospects. This review article summarizes the advances in the application of NIPPV in neonatal respiratory support to promote the understanding and standardization of this technique.
Airway Extubation ; Humans ; Infant, Newborn ; Intermittent Positive-Pressure Ventilation ; adverse effects ; instrumentation ; methods ; Prognosis

The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.
Bronchopulmonary Dysplasia ; Catheters* ; Continuous Positive Airway Pressure ; Hot Temperature* ; Humans ; Incidence ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units, Neonatal ; Intermittent Positive-Pressure Ventilation ; Noninvasive Ventilation ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical ; Weaning

OBJECTIVETo study the clinical efficacy of nasal synchronous intermittent mandatory ventilation (nSIMV) in premature infants with severe respiratory distress syndrome (RDS) after extubation.

METHODSA retrospective analysis on the clinical date of 126 premature infants with severe RDS who were hospitalized in the NICU between January 2013 and May 2015 was performed. Sixty-one premature infants who were hospitalized in the NICU between January 2013 and March 2014 received nasal continuous positive airway pressure (nCPAP) (nCPAP group) and 65 premature infants who were hospitalized in the NICU between April 2014 and May 2015 received nSIMV (nSIMV group). The blood gas analysis indexes, the rate of extubation failure, the causes of extubation failure and the incidence of complications were compared between the two groups.

RESULTSAfter 4 hours of treatment, the pH value, PaO2, SaO2 and oxygenation index in the nSIMV group were significantly higher than in the nCPAP group (P<0.05), meanwhile, the PaCO2 in the nSIMV group were significantly lower than in the nCPAP group (P<0.05). The rates of extubation failure in the nSIMV and nCPAP groups were 9% (6/65) and 30% (18/61) respectively (P<0.05). The extubation failure in the nSIMV and nCPAP groups was caused by hyoxemia (2% vs 5%; P>0.05), hypercapnia (6% vs 11%; P>0.05) and apnea (2% vs 13%; P<0.05). There were no differences in respirator support time, full enteral feeding time, the time to regain birth weight and the length of hospitalization between two groups (P>0.05). After treatment, the incidence of abdominal distension in the nSIMV group was significantly lower than in the nCPAP group (9% vs 30%; P<0.05) and there were no differences in the incidences of feeding intolerance, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity and bronchopulmonory dysplasia between the two groups.

CONCLUSIONSnSIMV for premature infants with severe RDS after extubation not only significantly improves lung function and reduces the rate of extubation failure, also results in a lower incidence of gastrointestinal side effects and does not increase the incidence of complications.

Airway Extubation ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Male ; Respiratory Distress Syndrome, Newborn ; therapy ; Retrospective Studies

PURPOSE: To investigate the pulmonary outcomes of early extubation (within the first 24 hours of life) with synchronized nasal intermittent positive pressure ventilation (NIPPV) in extremely premature infants born at 25-26 weeks' gestation. METHODS: Medical records of extremely premature infants (gestational age: 25-26 weeks) born and admitted to the Keimyung University Dongsan Medical Center between January 2015 and December 2015 (n=42) were reviewed retrospectively. The early extubation group included infants who were extubated within the first 24 hours of life and was compared with a control group that included infants who remained ventilated beyond the first 24 hours of life. Extubation failure was defined as the need for reintubation within 72 hours after extubation. RESULTS: Of the 35 enrolled infants, 22 (62.9%) were extubated within the first 24 hours of life. No significant differences in perinatal factors were observed between the early extubation and control groups. Between the two groups, the incidence rates of extubation failure (18.2% [4/22] vs. 7.7% [1/13], P=0.39), reintubation (50.0% [11/ 22] vs. 46.2% [6/13], P=0.84), mortality (18.2% [4/22] vs. 15.4% [2/13], P=0.83), and the combined rates of clinical bronchopulmonary dysplasia (BPD) or death (40.9% [9/22] vs. 38.5% [5/13], P=0.89) did not significantly differ. CONCLUSION: Early extubation (within the first 24 hours of life) with synchronized NIPPV is safe and effective in the extremely premature infants born at 25-26 weeks' gestation, and does not indicate increased risks of extubation failure and other morbidities.
Bronchopulmonary Dysplasia ; Humans ; Incidence ; Infant ; Infant, Extremely Premature* ; Infant, Newborn ; Intermittent Positive-Pressure Ventilation* ; Medical Records ; Mortality ; Noninvasive Ventilation ; Pregnancy ; Retrospective Studies

Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.
Anoxia ; Diagnosis ; Hemodynamics ; Intermittent Positive-Pressure Ventilation ; Needles ; Oxygen ; Pneumothorax* ; Respiration ; Skin ; Tracheoesophageal Fistula*

INTRODUCTIONLate preterm (LP) neonates (34 to 36 weeks gestation) are often managed like term neonates though current literature has identified them to have greater complications. The primary objective of our study was to evaluate and compare morbidity and resource utilisation in LPs especially in view of paucity of Asian studies in this regard.

MATERIALS AND METHODSA retrospective audit was carried out on 12,459 neonates born in KK Women's and Children's Hospital (KKWCH). The chief outcome measures were hypoglycaemia, hypothermia, respiratory morbidity, feeding problems and neonatal jaundice. Resource utilisation included neonatal intensive care unit (NICU) admission, mechanical ventilation, parenteral nutrition and length of hospitalisation.

RESULTSOf 12,459 deliveries, 1221 (10%) were LP deliveries with a significantly increasing trend of 8.6% to 10% from 2002 to 2008 (P = 0.001). Neonatal morbidity in the form of hypoglycaemia (34 weeks vs 35 to 36 weeks vs term: 26% vs 16% vs 1%); hypothermia (5% vs 1.7% vs 0.2%); feeding difficulties (30% vs 9% vs 1.4%); respiratory distress syndrome (RDS) (4% vs 1% vs 0.1%); transient tachypnea of the newborn (TTNB) (23% vs 8% vs 3%) and neonatal jaundice (NNJ) needing phototherapy (63% vs 24% vs 8%), were significantly different between the 3 groups, with highest incidence in 34-week-old infants. Resource utilisation including intermittent positive pressure ventilation (IPPV) (15% vs 3.5% vs 1%), total parenteral nutrition/intravenous (TPN/IV) (53% vs 17% vs 3%) and length of stay (14 ± 22 days vs 4 ± 4.7 days vs 2.6 ± 3.9 days) was also significantly higher (P <0.001) in LPs.

CONCLUSIONLP neonates had significantly higher morbidity and resource utilisation compared to term infants. Among the LP group, 34-week-old infants had greater complications compared to infants born at 35 to 36 weeks.

Clinical Audit ; Feeding Behavior ; Female ; Humans ; Hypoglycemia ; epidemiology ; Hypothermia ; epidemiology ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; utilization ; Intermittent Positive-Pressure Ventilation ; utilization ; Jaundice, Neonatal ; epidemiology ; therapy ; Length of Stay ; statistics & numerical data ; Male ; Parenteral Nutrition ; utilization ; Parenteral Nutrition, Total ; utilization ; Phototherapy ; Premature Birth ; epidemiology ; Respiration, Artificial ; utilization ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Transient Tachypnea of the Newborn ; epidemiology

In order to reduce the serious complications associated with invasive mechanical ventilation, non-invasive ventilation (NIV) has increasingly been chosen as the primary ventilation in preterm infants with respiratory distress syndrome (RDS). In the last 4 decades, nasal continuous positive airway pressure (NCPAP) has been as a main, or even the only mode of NIV in preterm infants with RDS. In the recent decade, improvements in sensors and nasal airway interfaces have resulted in the introduction of a variety of other new types of NIV, such as nasal intermittent positive pressure ventilation (NIPPV), bi-level positive airway pressure (BiPAP). Subsequent studies have shown that some new modes may be more superior to NCPAP in preterm infants with RDS. In order to further understand the application of various NIV modes, we review literatures about all kinds of NIV as a primary mode of ventilation in preterm infants with RDS.
Continuous Positive Airway Pressure ; Humans ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation ; Noninvasive Ventilation ; Respiratory Distress Syndrome, Newborn ; therapy