Flow-driver-generated synchronized nasal intermittent positive-pressure ventilation versus biphasic positive airway pressure after extubation in preterm infants

Objective: To compare the efficacy and safety of flow-driver-generated synchronized nasal intermittent positive-pressure ventilation (SNIPPV) and biphasic positive airway pressure (BiPAP) after extubation in preterm infants. Hypothesis: SNIPPV delivered via a flow-driver device improves post-extubation outcomes compared with non-synchronized BiPAP. Study Design: This single-center, retrospective, observational cohort study was conducted in the neonatal intensive care unit of Nagoya University Hospital, Nagoya, Japan. Patient Selection: Preterm infants born at <34 weeks of gestation who underwent endotracheal ventilation after birth and were subsequently supported with either BiPAP (from October 2017 to March 2020) or SNIPPV (from April 2020 to September 2022) after extubation. Infants with major anomalies or surgical ventilator dependence were excluded. Methodology: Data on demographic and clinical characteristics, respiratory outcomes, and complications were collected. The primary outcome was reintubation within 72 hours. Secondary outcomes were bronchopulmonary dysplasia (BPD), respiratory support duration, and major complications. Results: Sixty-seven infants were included (BiPAP n = 37, SNIPPV n = 30). Reintubation within 72 hours occurred in 6.7% and 29.7% of infants in the SNIPPV and BiPAP groups, respectively (p = 0.028). The incidence of respiratory distress-related failure was significantly lower in the SNIPPV group (3.3% vs. 24.3%, p = 0.019). There were no significant differences in BPD at 36 or 40 weeks, oxygen therapy duration, or complications such as necrotizing enterocolitis, retinopathy of prematurity, or severe neurological injury. Conclusion: Flow-driver-generated SNIPPV significantly reduces early extubation failure in preterm infants compared to BiPAP without increasing the rate of adverse outcomes. This is a practical and effective alternative to noninvasive respiratory support.