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Avoiding or reducing time on mechanical ventilation is crucial to reduce lung injury and bronchopulmonary dysplasia in extremely preterm infants (gestational age, <30 weeks and birth weight <1000 g). Noninvasive support via continuous positive airway pressure (CPAP) often fails because of apnea, high chest wall compliance, or both, leading to intubation rates of 40% to 80%. The addition of nasal intermittent positive-pressure ventilation (NIPPV) to CPAP was proposed as a solution to these barriers to noninvasive respiratory support. Early reports and single-center trials provided optimism that reintubation rates could be reduced, creating hope that longer-term benefits were also possible.
The multinational NIPPV Study Group randomized 1009 e…