There is some evidence that nasal intermittent positive pressure ventilation (NIPPV) increases the effectiveness of nasal continuous positive airway pressure (NCPAP) in preterm babies who no longer need an endotracheal tube (tube in the windpipe). Preterm babies with breathing problems often require help from a machine (ventilator) that provides regular breaths through a tube in the windpipe. The process of extubation or removal of this tube does not always go smoothly and the tube may need to go back in if the baby cannot manage by him/herself. NCPAP and NIPPV are ways of supporting babies' breathing in a less invasive way - the tubes are shorter and go only to the back of the nose and, therefore, cause less damage to the lungs. NCPAP and NIPPV may be used after extubation to reduce the number of babies that need to have the endotracheal tube reinstated. NCPAP provides steady pressure to the back of the nose that is transmitted to the lungs, helping the baby breathe more comfortably. NIPPV provides the same support, but also adds some breaths from the ventilator.
We search scientific databases for studies comparing NCPAP with NIPPV in preterm infants (born before 37 completed weeks of pregnancy) who no longer needed an endotracheal tube. We looked at breathing problems, the need for the endotracheal tube to be reinstated and side effects. The evidence is current to August 2013.
We found eight trials comparing NCPAP with NIPPV. Five out of eight studies that compared NCPAP and NIPPV showed that NIPPV reduced the need for the endotracheal tube to be replaced. Further studies are needed to determine how best to deliver NIPPV to infants.
Quality of the evidence
The quality of the studies included in this review was overall good.