AIM: To determine whether early nasal intermittent positive pressure ventilation (NIPPV), in comparison to early continuous positive airway pressure (CPAP), can reduce the need for intubation and mechanical ventilation in preterm neonates with suspected respiratory distress syndrome (RDS). METHODS: In this stratified open-label randomized controlled trial, neonates (28 to 34 weeks gestation) with respiratory distress within 6 h of birth and Downe's score >= 4 were eligible. Subjects were randomly allocated to 'early-NIPPV' or 'early-CPAP' after stratifying for gestation (28 to 30 weeks, 31 to 34 weeks) and surfactant use. Primary outcome was failure of the allocated mode within 48 h. RESULTS: Seventy-six neonates were enrolled (37 in 'early-NIPPV' and 39 in 'early-CPAP' groups). Failure rate was less with 'early-NIPPV' versus 'early-CPAP'(13.5% versus 35.9%, respectively, RR 0.38 (95% CI 0.15 to 0.89), p = 0.024). Similarly, need for intubation and mechanical ventilation by 7 days (18.9% versus 41%, p = 0.036) was less with NIPPV. Failure rate with NIPPV was less in the subgroups of subjects born at 28 to 30 weeks (p = 0.023) and who did not receive surfactant (p = 0.018). CONCLUSION: Among preterm infants with suspected RDS, early use of NIPPV reduces the need for intubation and mechanical ventilation compared to CPAP.

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