Ventilation and other medical interventions are often used on pre-term infants to improve lung function and prolong early life long enough to allow the lungs to develop properly and sustain life without medical intervention. According to researchers from The Children’s Hospital of Philadelphia, ventilation and other current therapy are not working as well as medical professionals once thought. The study was published in the New England Journal of Medicine.

The two current methods of treatment are CPAP (continuous positive air pressure) and IPPV (intermittent positive-pressure ventilation). Both help prevent the lungs from collapsing making it easier for the pre-term infant to breathe while reducing possible inflammation or injury associated with lung collapse. Both CPAP and IPPV provide positive pressure, but CPAP offers continuous pressure while IPPV provides positive pressure with a spike during the inhale. IPPV is more complicated, but the extra pressure is thought to make IPPV more effective than CPAP. Researchers decided to find out if this theory was correct and if IPPV protected the pre-term infant from BPD (bronchopulmonary dysplasia); a common side effect of intubation that results in inflammation and scarring in the lungs. This inflammation and scarring can cause premature death or neurological damage in pre-term infants.

Researchers randomly placed infants (1009 in all) into a CPAP or IPPV group. All infants were born weighing less than 1000 grams at birth and at less than 30 weeks gestation. At the conclusion of the study, IPPV was no better at preventing BPD than CPAP and no more effective at preventing other complications.

According to study findings, current non-invasive methods – CPAP and IPPV – offer generally the same support to pre-term infants with the same rate of complications, risk of complications and rate of neonatal death between the two groups. BPD rates were similar between the CPAP and IPPV groups as well.

Researchers concluded that while medical professionals believe the more complicated IPPV offers better potential outcomes for the preterm infant, which may not be the case. Researchers go on to state new research and development of new treatment protocols are necessary to reduce side effects and BPD in preterm infants as current non-invasive methods are simply not as effective as once thought.

Source: Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS; NIPPV Study Group. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med. 2013 Aug 15;369(7):611-20. doi: 10.1056/NEJMoa1214533.