SNIPPV vs NIPPV: does synchronization matter?

Objective: To compare clinical outcomes of premature infants on synchronized nasal intermittent positive pressure ventilation (SNIPPV) vs nasal intermittent positive pressure ventilation (NIPPV) in the neonatal intensive care unit. Use of NIPPV in the neonatal intensive care unit has shown promise with better clinical outcomes in premature neonates. It is not known if synchronization makes a significant clinical impact when using this technique. Study Design: Retrospective data were obtained (1/04 to 12/09) of infants who received NIPPV anytime during their stay in the neonatal intensive care unit. SNIPPV (Infant Star with StarSync) was utilized from 2004 to 2006, whereas NIPPV (Bear Cub) was used from 2007 to 2009. Bronchopulmonary dysplasia (BPD) was defined using the NIH consensus definition. Unadjusted associations between potential risk factors and BPD/death were assessed using the chi(2) or Wilcoxon rank-sum test. Adjusted analyses were performed using generalized linear mixed models, taking into account correlation among infants of multiple gestation. Result: There was no significant difference in the mean gestational age and birth weight in the two groups: SNIPPV (n = 172; 27.0w; 1016 g) and NIPPV (n = 238; 27.7w; 1117 g). There were no significant differences in maternal demographics, use of antenatal steroids, gender, multiple births, small for gestational age or Apgar scores in the two groups. More infants in the NIPPV group were given resuscitation in the delivery room (SNIPPV vs NIPPV: 44.2 vs 63%, P < 0.001). Use of surfactant (84.4 vs 70.2%; P < 0.001) was significantly higher in the SNIPPV group. There were no differences in the rate of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity and necrotizing enterocolitis in the two groups. After adjusting for the significant variables, use of NIPPV vs SNIPPV (odds ratio 0.74; 95% confidence interval: 0.42, 1.30) was not associated with BPD/death. Conclusion: These data suggest that use of SNIPPV vs NIPPV is not significantly associated with a differential impact on clinical outcomes. Journal of Perinatology (2012) 32, 438-442; doi:10.1038/jp.2011.117; published online 24 November 2011