Nasal Intermittent Positive Pressure Ventilation in Preterm Infants

To prevent apnea of prematurity (AOP), respiratory muscle fatigue and
respiratory failure, most preterm infants need respiratory support.
Non-invasive respiratory support is preferred in neonatology because invasive
ventilation is associated with chronic pulmonary disease and developmental
problems. Nasal intermittent positive pressure ventilation (nIPPV) is a
non-invasive mode providing positive inspiratory pressure (PIP) as well as
positive end-expiratory pressure (PEEP) mimicking endotracheal ventilation. The
way nIPPV prevents respiratory failure is unclear and the benefits of
synchronizing the mechanical inflation to the patients* spontaneous breaths
have not been determined.
Patient-ventilator asynchrony is widely described in adult patients by
detecting spontaneous breathing with diaphragm electromyography. Recent studies
show adverse effects on respiratory muscle function and clinical outcome.
However, in preterm neonates the incidence of patient-ventilator asynchrony
during nIPPV is not well described and effects of asynchrony on lung function
and diaphragm have not been studied.

To describe the synchronicity of nIPPV respiratory support with spontaneous
diaphragm activity and the effect of asynchrony of mechanical inflations and
spontaneous breaths on lung volume, mechanical parameters and diaphragm
activity in preterm infants.

Prospective observational study.

This study can only be done with preterm subjects because of the specific
physiology of the immature respiratory network and immature lung development in
this specific population. The study population will not have benefit from
participating in this research. This study will provide information on
respiratory support in preterm infants, which is thought to improve and
optimize future care for these patients. The measurement techniques used are
non-invasive and well tolerated.