Studies assessing long-term respiratory outcomes of early noninvasive ventilation strategies in preterm infants

First author [ref.]Patients nBirthweight; GAAge time of study#MethodsPrimary outcomeResultsCriticisms
COIN trial
Roehr [52]39 (17 nCPAP + 22 MV)Mean 950 g; 25–28 weeks8 weeksSingle-centre, subcohort study. Randomised after birth to nCPAP versus intubation, surfactant and MV. PFT: dead-space free flow, occlusion test and body plethysmographyPulmonary function and morbidityCPAP group had lower RR, minute ventilation, better compliance, higher respiratory time constant and improved elastic WOB. No differences in FRC and morbiditySample size. CPAP group had fewer doses of surfactant, days of MV and shorter total respiratory support and oxygen supplementation
Stevens [9]918 (474 nCPAP + 444 MV)Mean 850 g; 24–27 weeksAt hospital discharge, at 6, 12 and 18–22 monthsProspective secondary, multicentre (20 centres) study. Randomised after birth to one of two respiratory strategies: lower (85–89%) versus higher (91–95%) oxygen saturation targets and early CPAP versus early intubation and surfactant administration by 1 h of life. Parental questionnairesPulmonary morbidityAt 6 months, the lower oxygen saturation target group had less wheezing and use of nebulised medications. nCPAP group had less respiratory morbidities at 6 and 18–22 months (respiratory illnesses, treatment with oxygen or diuretics at home and hospitalisation). Significant differences in respiratory outcomes for infants with and without BPDData were obtained by parental report, which has the potential for classification and recall bias

GA: gestational age; COIN: Continuous Positive Airway Pressure or Intubation at Birth; SUPPORT: Surfactant, Positive Pressure, and Oxygenation Randomized Trial; nCPAP: nasal continuous positive airway pressure (CPAP); MV: mechanical ventilation; PFT: pulmonary function test; RR: respiratory rate; WOB: work of breathing; FRC: functional residual capacity; BPD: bronchopulmonary dysplasia. #: ages at the study time are given in corrected age.