# Nasal intermittent positive pressure ventilation in neonates with grade 3 bronchopulmonary dysplasia

## TL;DR

A new nasal ventilation strategy helps some severe BPD neonates avoid tracheostomy, reducing hospital stays.

## Contribution

A novel NIPPV strategy is proposed for Grade 3 BPD neonates, potentially avoiding tracheostomy.

## Key findings

- 28 non-tracheostomy patients had shorter hospital stays compared to 17 tracheostomy patients.
- Tracheostomy patients were more likely to have subglottic stenosis and were discharged later.
- NIPPV successfully supported a subset of Grade 3 BPD neonates without tracheostomy.

## Abstract

We describe a novel strategy of nasal intermittent positive pressure ventilation (NIPPV) to support patients with Grade 3 bronchopulmonary dysplasia (BPD).

This is a retrospective study of Grade 3 BPD patients treated with NIPPV and discharged from a single center from January 2020 to May 2024. Patients were grouped into discharged without tracheostomy vs with tracheostomy. Groups were assessed for clinical differences, and the NIPPV strategy is described.

There were 28 non-tracheostomy and 17 tracheostomy patients. There were no differences in gestational age, birthweight, or respiratory severity score at key dates. Tracheostomy patients were more likely to have subglottic stenosis (53% vs 3.6%, p = 0.0001) and were older at discharge home [median 447 (411–479) vs 252 (184–309) days, p < 0.0001].

A subset of Grade 3 BPD patients can be supported with NIPPV. The non-tracheostomy group had decreased length of stay compared to the tracheostomy group.