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


Objective To determine the change in non-invasive ventilation (NIV) use over time in infants born at <32 weeks’ gestation and the associated clinical outcomes.

Study design Retrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.

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.

  • neonatology
  • intensive care units
  • neonatal
  • epidemiology

Data availability statement

Data are available on reasonable request. Data may be obtained from a third party through the National Neonatal Research Database with relevant approvals. The National Neonatal Research Database is a National Data Asset, a registry containing the Neonatal Data Set (a National Data Standard). Details of data items are searchable at the following webpage:

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  • Original research
    Alejandro Avila-Alvarez Carlos Zozaya Sonia Pértega-Diaz Manuel Sanchez-Luna Martin Iriondo-Sanz Maria Dolores Elorza Fermín García-Muñoz Rodrigo Spanish Neonatal Network SEN1500 Gemma Ginovart Josep Figueras Aloy Alberto Pérez Legorburu Ramon Aguilera Olmos Eduardo Narbona López Sandra Terroba Tomás Sanchez-Tamayo Dolores Elorza Fernandez Araceli Corredera Sánchez Belén Fernández Colomer Ma Angeles Martinez Fernandez De las Cuevas Terán Miguel Cortajarena Altuna Carmen Macias Díaz Pedro Fuster Jorge Segundo Rite Gracia Purificación Ventura Faci Isabel Izquierdo Macián Ana Belén Escobar-Izquierdo Luz Couce Pico Elena Pilar Gutierrez-González D Blanco Bravo Yolanda Ruiz del Prado Lourdes Urquía Martí Rafael Garcia Mozo Pilar Jaraba Caballero Cristina de Frutos Martínez Sílvia Martínez-Nadal Martin Iriondo Amaya Rodriguez Serna María Gonzalez Santacruz Maria Fernanda Moreno-Galdo Joan Badia Barnusell Mar Montejo Vicente Aintzane Euba; Mar Albújar Irene Cuadrado Perez Andres Martinez Gutierrez Gemma Ginovart Galiana Jesús López Cuesta José Santos Muñoz María Suárez Albo Víctor Manuel Marugán-Isabel María Victoria Ramos Gerardo Romera Modamio Carolina Vizcaíno David Mora Navarro Laura Acosta Gordillo Eduard Soler Mir Mercedes Granero Asensio Javier Estañ Capell Miguel Angel García-Cabezas D López Gómez Alberto Trujillo Fagundo Israel Anquela Sanz Antonio Segado Arenas Carmen Rosa Pallás-Alonso Sabina Romero Carmen González Armengod Jose María Lloreda-García Laura Domingo Comeche Laura Castells Vilella Concepción Goñi Orayen Dolores Muro Sebastian Mara Fernandez Diaz Elena García Victori