Comparison of nasal intermittent positive pressure ventilation and continuous positive airway pressure on improving bronchopulmonary dysplasia outcomes in preterm infants

Purpose To compare early nasal intermittent positive pressure ventilation (NIPPV) vs. nasal continuous positive airway pressure (NCPAP) in preterm infants and to evaluate their associations with bronchopulmonary dysplasia (BPD) and respiratory outcomes. Methods This retrospective cohort study included 200 preterm infants who received either NIPPV ( n = 100) or NCPAP ( n = 100) as initial non-invasive respiratory support within 24 h after birth. Data on respiratory support, arterial blood gases, BPD at 36 weeks postmenstrual age, reintubation, feeding outcomes, other morbidities, and hospitalization duration were compared. Results The primary outcome was bronchopulmonary dysplasia (BPD). The incidence of BPD was lower in the NIPPV group ( P = 0.011). Secondary outcomes included lower rates of invasive ventilation ( P = 0.010), higher minimum pH ( P = 0.017), lower maximum partial pressure of carbon dioxide (PaCO 2 ) ( P = 0.011), higher minimum partial pressure of oxygen (PaO 2 ) ( P = 0.037), shorter duration of oxygen therapy ( P = 0.012), lower reintubation rate within the first week ( P = 0.010), and shorter hospital stay ( P = 0.025). Multivariable analysis identified NIPPV as an independent protective factor against BPD (OR = 0.446, P = 0.005). No significant differences were observed in other neonatal morbidities or feeding outcomes. Conclusion Early NIPPV compared to NCPAP is associated with reduced need for invasive ventilation, improved gas exchange, lower incidence of BPD, and shorter hospitalization in preterm infants without increasing adverse events.