• Jucille Meneses, Vineet Bhandari, and Joao G Alves.
• Division of Neonatology, Instituto de Medicina Integral Professor Fernando Figueira, Ave Boa Viagem 2080, Apt 2801, Recife, PE, Brazil. jucille.meneses@gmail.com.br
• Arch Pediatr Adolesc Med. 2012 Apr 1;166(4):372-6.

ObjectiveTo determine among preterm infants with respiratory distress syndrome whether the use of early nasal intermittent positive-pressure ventilation (NIPPV) vs nasal continuous positive airway pressure (NCPAP) decreases the need for invasive ventilation within the first 72 hours of life.Data SourcesMEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were searched, as well as abstracts from meetings of the Pediatric Academic Societies.Study SelectionRandomized controlled trials involving infants with respiratory distress syndrome who received NIPPV vs NCPAP.Data ExtractionData were extracted on the use of NIPPV vs NCPAP. Also extracted were data on the need for invasive ventilation within the first 72 hours of life and the incidences of bronchopulmonary dysplasia, pneumothorax, necrotizing enterocolitis, and intraventricular hemorrhage, as well as the time to full feeds and the duration of hospital stay.Data SynthesisThree trials were included (n = 360). A significant decrease in the need for invasive ventilation was found in the NIPPV group (risk ratio, 0.60; 95% CI, 0.43-0.83). No difference between groups was found in the incidence of bronchopulmonary dysplasia (risk ratio, 0.56; 95% CI, 0.09-3.49). No differences in the other outcomes were observed between the 2 groups.ConclusionsAmong preterm infants with respiratory distress syndrome, NIPPV decreases the need for invasive ventilation within the first 72 hours of life compared with NCPAP. Trials are needed to assess whether NIPPV minimizes the occurrence of bronchopulmonary dysplasia and other comorbidities.

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