Noninvasive Positive Airway Pressure Management for Post-extubation Support in Preterm Infants: Observational Cohort Study with Overlap Weighting Analysis

Wakana Maki; Nobuaki Michihata; Yohei Hashimoto; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga

doi:10.37737/ace.24004

Noninvasive Positive Airway Pressure Management for Post-extubation Support in Preterm Infants: Observational Cohort Study with Overlap Weighting Analysis

Ann Clin Epidemiol. 2023 Nov 10;6(1):17-23. doi: 10.37737/ace.24004. eCollection 2024.

Authors

Wakana Maki¹, Nobuaki Michihata², Yohei Hashimoto¹, Hiroki Matsui¹, Kiyohide Fushimi³, Hideo Yasunaga¹

Affiliations

¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.
² Department of Health Services Research, Graduate School of Medicine, The University of Tokyo.
³ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine and Dental Sciences.

Abstract

Background: Nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), and high-flow nasal cannula (HFNC) are often used after initial extubation in preterm infants. However, data regarding the choice between NCPAP/NIPPV and HFNC are limited. This study examined which therapy was more effective as post-extubation support.

Methods: This is a retrospective, cohort study that used the Diagnosis Procedure Combination database in Japan, 2011-2021. Propensity score overlap weighting analyses were performed to compare the composite outcomes of in-hospital death and reintubation in preterm infants who received NCPAP/NIPPV and HFNC. We identified infants born at gestational age 22-36 weeks who were intubated within 1 day of birth. We included patients who underwent NCPAP/NIPPV or HFNC after initial extubation. Patients with airway obstruction or congenital airway abnormalities were excluded.

Results: We identified 1,203 preterm infants treated with NCPAP/NIPPV (n = 525) or HFNC (n = 678). The median (interquartile range) gestational age at delivery was 30 (27-33) weeks, and birth weight was 1296 (884-1,802) g. Compared with the HFNC group, the NCPAP/NIPPV group had a significantly lower proportion of the composite outcome after the overlap weighting analysis (risk ratio, 0.62; 95% confidence interval, 0.47 to 0.83; p = 0.001). This significant difference was also observed in infants born at gestational age 22-31 weeks, whereas no significant difference was observed in infants born at gestational age 32-36 weeks.

Conclusions: NCPAP/NIPPV may be a superior post-extubation support than HFNC in preterm infants, especially in those born at gestational age of 22-31 weeks.

Keywords: Airway Extubation; Cannula; Continuous Positive Airway Pressure/instrumentation; Infant; Observational study; Premature.