Nasal continuous positive airway pressure (NCPAP) or noninvasive neurally adjusted ventilatory assist (NIV-NAVA) for preterm infants with respiratory distress after birth: A randomized controlled trial

Objectives To compare rates of treatment failure between the use of nasal continuous positive airway pressure (NCPAP) and noninvasive neurally adjusted ventilatory assist (NIV-NAVA) in infants with respiratory distress after birth. Methods A randomized, unblinded, double-center trial was conducted in infants with birth weights (BWs) less than or equal to 1500 g and respiratory distress receiving noninvasive respiratory support for less than or equal to 48 hours of life; some infants were initially treated with minimally invasive surfactant therapy as the standard of care. Primary outcome: need for endotracheal intubation with use of mechanical ventilation (MV) at less than or equal to 72 hours of life using prespecified failure criteria. Secondary outcomes: use of surfactant, duration of noninvasive support, duration of MV, bronchopulmonary dysplasia (BPD) and death. Results A total of 123 infants were included (NCPAP group = 64 and NIV-NAVA group = 59). Population characteristics were similar between groups. No difference in the primary outcome was observed: NCPAP = 10 (15.6%) and NIV-NAVA = 12 (20.3%), P = .65. Groups were also similar in the use of surfactant (19 vs 17), duration of noninvasive support (147 +/- 181 hours vs 127 +/- 137 hours), BPD incidence and death. However, duration of MV was significantly longer in NCPAP group (95.6 +/- 45.8 hours vs 28.25 +/- 34.1 hour), P = .01. Conclusion In infants with respiratory distress after birth, no differences in treatment failures were observed between NIV-NAVA and NCPAP. These results require further evaluation in a larger study.