Is NIV Superior to CPAP in Maintaining Targeted Oxygen Saturation Ranges in Preterm Infants on Moderate Noninvasive Respiratory Support?

Abstract

Background:

Noninvasive ventilation (NIV) and CPAP are noninvasive respiratory support modalities commonly used in preterm infants. There is conflicting data on the superiority between these two modes of noninvasive respiratory support. The objective of this study was to determine if oxygen saturation is more within the target range on NIV compared to CPAP using the data from histograms.

Methods:

Retrospective analysis of premature neonates (< 1,500 grams, gestational age < 30 weeks) admitted to the NICU for which oxygen saturation histogram data was available one day before and after the transition between NIV and CPAP. FIO₂ at the time of data collection was greater than 0.21. This histogram data and the percentage of time spent in certain SpO₂ ranges was compared before and after the de-escalation from NIV to CPAP or escalation from CPAP to NIV. FIO₂ was additionally compared between the two modes of respiratory support.

Results:

A total of 26 infants were included. The median gestational age was 25.5 weeks and the median weight of the infants was 792 g. Among the 26 infants, there were 34 episodes of transition between NIV and CPAP, 19 switches from NIV to CPAP, and 15 from CPAP to NIV. The percentage of time that oxygen saturation was within the target range (89-94 %) was not statistically significant between the two modes of respiratory support (CPAP 39.9% vs. NIV 43.9%, P = .09) (Table 1). The percentage of time that oxygen saturation was between 86-88% was higher on NIV and the percentage of time that oxygen saturation was >94% was higher on CPAP. There was a trend towards lower FIO₂ on NIV compared to CPAP. When switched from NIV to CPAP, there was a higher percentage of time spent above the target range (> 94%) while on CPAP (56% vs 49%, P = .001), and below the target range (86-88%) while on NIV (5.0% vs 1.4%, P = .02) (Table 3). When switched from CPAP to NIV, there was no difference in oxygen saturation ranges.

Conclusions:

Target oxygen saturation ranges on histogram data were similar in premature infants when supported on CPAP and NIV. However, oxygen saturation below the target range was more frequent on NIV compared to CPAP. NIV was not superior to CPAP in maintaining oxygen saturation within the target range in premature infants on moderate noninvasive respiratory support. The potential risk of low oxygen saturation range while supported on NIV in preterm infants requires further research.

Table 1 Respiratory support and oxygen saturation

	CPAP	NIPPV	p
FiO2	28 (25-37.1)	27 (23.9-35.0)	0.08
O2 Saturation (%)
<70	0 (0-0)	0 (0-0)	0.8
70-85	2.3 (1.1-5.1	3.5 (1.4-6.8)	0.1
86-88	3.2 (1.3-6.9)	5.0 (2.6-9.1)	0.04
89-94	39.9 (21.8-46.4)	43.9 (31.5-55.7)	0.09
<94	52.6 (40.3-77.6)	42.2 (29.2-58.6)	0.02

Table 2 Respiratory support and oxygen saturation switching from CPAP to NIPPV (n=15) & Table 3 Respiratory support and oxygen saturation switching from NIPPV to CPAP (n=19)

Table 2
	CPAP	NIPPV	p
FiO2	34 27.0-41.5	30.0 (26.0-37.0)	0.1
O2 Saturation (%)
<70	0 (0-0)	0 (0-0)	0.1
70-85	4.2 (1.4-7.0)	6.0 (1.7-7.7)	0.5
86-88	5.8 (2.4-10.7)	5.6 (3.5-11.5)	0.8
89-94	42.1 (29.0-46.0)	44.4 (35.4-59.6)	0.6
<94	50.1 (21.0-55.2)	34.6 (24.6-48.6)	0.4
Table 3
	CPAP	NIPPV	p
FiO2	26 (25-35)	25 (23.5-32)	0.2
O2 Saturation (%)
<70	0 (0-0)	0 (0-0)	0.2
70-85	1.7 (1.1-4.6)	2.8 (1.1-6.7)	0.09
86-88	1.4 (0-4.9)	5.0 (2.1-6.5)	0.02
89-94	30.5 (19.7-47.6)	43.7 (27.0-53.2)	0.08
>94	56.0 (42.9-78.5)	49.0 (31.4-64.3)	0.001