Nasal Intermittent Positive Pressure Ventilation During Neonatal Endotracheal Intubation: A Randomized Controlled Trial

Background: This prospective, multicenter, randomized controlled trial aimed to determine whether the use of nasal intermittent positive pressure ventilation (NIPPV) during neonatal endotracheal intubation increased the rate of successful intubation without physiological instability during all intubation attempts. Material and Methods: In total, 150 infants were randomly assigned to either an NIPPV or standard care group (n = 75 each). The primary outcome was successful intubation without physiological instability (defined as >= 20% decline in the peripheral oxygen saturation [SpO(2)] from preintubation value or bradycardia with a heart rate <100 beats/min) during all intubation attempts. Results: The mean postmenstrual age of the infants was 32.5 weeks, with a median weight of 1552 g at the time of intubation. The incidence of successful intubation without physiological instability during all intubation attempts was significantly higher in the NIPPV group (64%) than that in the standard care group (42.7%) (p = 0.009). This difference was particularly significant when inexperienced practitioners were involved. In the NIPPV group, the rates of bradycardia (18.7% vs. 41.3%) and severe desaturation (30.7% vs. 49.3%) were significantly lower, whereas the lowest SpO2 (85% vs. 76%) and lowest heart rate (118 vs. 105 beats/min) were significantly higher. Conclusion: NIPPV during endotracheal intubation increased the incidence of successful intubation without physiological instability during intubation attempts in neonates while reducing the rate of hypoxia and bradycardia.