Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes

This analysis of the National Neonatal Research Database from 2010-17 shows that the use of high-flow nasal cannula quadrupled, particularly as initial respiratory support, but was associated with adverse outcomes including BPD. Objective To determine the change in non-invasive ventilation (NIV) use over time in infants born at Study design Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at Results In 56 537 infants, NIV use increased significantly between 2010 and 2017 (continuous positive airway pressure (CPAP) from 68.5% to 80.2% in 2017 and high flow nasal cannula (HFNC) from 14% to 68%, respectively) (p<0.001)). Use of NIV as the initial mode of respiratory support also increased (CPAP, 21.5%-28.0%; HFNC, 1%-7% (p<0.001)). HFNC was used earlier, and for longer, in those who received CPAP or mechanical ventilation. HFNC use was associated with decreased odds of death before discharge (adjusted OR (aOR) 0.19, 95% CI 0.17 to 0.22). Infants receiving CPAP but no HFNC died at an earlier median chronological age: CPAP group, 22 (IQR 10-39) days; HFNC group 40 (20-76) days (p<0.001). Among survivors, HFNC use was associated with increased odds of bronchopulmonary dysplasia (BPD) (aOR 2.98, 95% CI 2.81 to 3.15) and other adverse outcomes. Conclusions NIV use is increasing, particularly as initial respiratory support. HFNC use has increased significantly with a sevenfold increase soon after birth which was associated with higher rates of BPD. As more infants survive with BPD, we need robust clinical evidence, to improve outcomes with the use of NIV as initial and ongoing respiratory support.

Automated summary

The analysis of the National Neonatal Research Database from 2010-17 revealed a significant increase in the use of NIV, particularly high-flow nasal cannula, which was associated with reduced odds of death before discharge but increased odds of bronchopulmonary dysplasia (BPD) and other adverse outcomes. The study emphasizes the need for robust clinical evidence to improve outcomes with the use of NIV as initial and ongoing respiratory support, as NIV use is increasing, especially as initial respiratory support.