A new randomised trial has found that a more complex backup ventilation strategy did not improve oxygen saturation control in extremely preterm infants receiving nasal continuous positive airway pressure (nCPAP) therapy.
Evaluating a New Ventilation Approach
Maintaining oxygen saturation within a safe target range remains a major challenge in the care of extremely preterm infants, who are vulnerable to both low and excessive oxygen levels. Nasal intermittent positive pressure ventilation (NIPPV) is commonly used as a backup during episodes of apnoea, but the optimal way to discontinue support once spontaneous breathing resumes remains uncertain.
Researchers compared two approaches: immediate cessation of backup NIPPV when spontaneous respiration restarted and a newer strategy involving gradual, stepwise reduction of ventilatory support.
No Improvement in Oxygen Saturation
The study enrolled 24 extremely preterm infants with a median gestational age of just over 24 weeks. Participants were randomly assigned to receive both ventilation strategies in a crossover design.
The primary outcome, time spent within the target oxygen saturation range of 88–95%, was similar between the two approaches. Infants spent 61.1% of the time within the target range during immediate cessation and 64.7% during stepwise reduction, a difference that was not statistically significant.
Similar Rates of Desaturation Events
Researchers also found no significant differences in time spent above or below the target oxygen range, nor in the frequency of prolonged or severe oxygen desaturation episodes.
Measures of cerebral oxygenation likewise remained comparable between the two ventilation modes, suggesting that the newer strategy did not provide additional neurological benefits.
Increased Airway Pressure Without Clinical Benefit
Although stepwise reduction resulted in higher mean airway pressure and a modest reduction in respiratory rate, these physiological changes did not translate into improved oxygen control or other clinically meaningful outcomes.
Heart rate, oxygen requirements, and carbon dioxide levels were similar across both treatment strategies.
Importance of Testing New Technologies
The authors concluded that increasingly sophisticated ventilation technologies should not be assumed to offer clinical advantages without rigorous evaluation.
The findings highlight the importance of testing new neonatal respiratory support strategies in well-designed clinical trials before widespread adoption, particularly in vulnerable populations such as extremely preterm infants.
According to the investigators, the study demonstrates that technological complexity alone does not necessarily improve patient outcomes and reinforces the value of evidence-based implementation in neonatal intensive care.
Reference
Ströbele S et al. Time spent within the SpO2 target range during nasal CPAP therapy with different backup modes in extremely preterm infants: a randomised cross-over trial. BMJ Open Respiratory Research. 2026;13:e003530.
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