---
title: "Nasal HFOV and NIPPV as Primary Support for Preterm RDS: Current Evidence and Gaps"
id: "pubmed-42920000"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42920000"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42920000/"
doi: "10.1007/s00431-026-07556-4"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nasal HFOV and NIPPV as Primary Support for Preterm RDS: Current Evidence and Gaps
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42920000
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42920000/)
- **DOI:** [10.1007/s00431-026-07556-4](https://doi.org/10.1007%2Fs00431-026-07556-4)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The review evaluated non-invasive primary respiratory supports for **respiratory distress syndrome (RDS)** in **preterm infants**, focusing on CPAP, nasal intermittent positive pressure ventilation, and nasal high-frequency oscillatory ventilation. - Investigators noted that continuous positive airway pressure (**CPAP**) remains first-line therapy but may fail in up to 50% of extremely preterm infants, creating a need for advanced non-invasive options. - Randomized and comparative data indicate both **NIPPV** and **nHFOV** reduce treatment failure and intubation rates compared with CPAP; these effects were observed consistently for NIPPV and reported for nHFOV particularly in extremely preterm cohorts. - The study team observed that direct head-to-head randomized controlled trials comparing **nHFOV** with **NIPPV** as primary support are scarce; available indirect comparisons carry low certainty. - Data indicated each modality has distinct physiological rationales and evidence profiles; neither modality has proven superiority over the other based on current evidence. - Authors recommended that clinicians consider local expertise, equipment availability, and gestational age when choosing between NIPPV and nHFOV. - The review concluded that both modalities are viable beyond CPAP in clinical practice, but emphasized the urgent need for robust, well-powered head-to-head RCTs to inform optimal primary respiratory support strategies in extremely preterm infants. - Conflict of interest: authors declared no competing interests. - The source did not provide detailed dosing, ventilator settings, or specific trial sizes for the comparisons reported in the abstract.
## Clinical Analysis & Structured Key Points
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VDumpa@uams.edu.") Affiliations Expand ### Affiliations * 1 Department of Neonatal-Perinatal Medicine, Mc Master University, Hamilton, ON, Canada. * 2 Specialist Neonatology, Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates. * 3 Department of Neonatology, Viswabharathi Medical College & General Hospital, Kurnool, Andhra Pradesh, India. * 4 Department of Neonatology, Institute of Postgraduate Medical Education & Research, Kolkata, India. * 5 Department of Neonatology, Ankura Children's Hospital, L B Nagar, Hyderabad, Telangana, India. * 6 Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, NJ, 08103, USA. * 7 Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. VDumpa@uams.edu. * PMID: **42920000** * DOI: [ 10.1007/s00431-026-07556-4 ](https://doi.org/10.1007/s00431-026-07556-4) Item in Clipboard Review # Nasal high-frequency oscillatory ventilation as primary respiratory support in preterm infants with respiratory distress syndrome: current evidence and clinical implications Sumayya Hafeez et al. Eur J Pediatr. 2026. Show details Display options Display options Format Abstract PubMed PMID Eur J Pediatr Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+J+Pediatr%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+J+Pediatr%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) . 2026 Oct 24;185(11):882. doi: 10.1007/s00431-026-07556-4. ### Authors [Sumayya Hafeez](https://pubmed.ncbi.nlm.nih.gov/?term=Hafeez+S&cauthor_id=42920000)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-1 "Department of Neonatal-Perinatal Medicine, Mc Master University, Hamilton, ON, Canada."), [Venkateshwarlu Vardhelli](https://pubmed.ncbi.nlm.nih.gov/?term=Vardhelli+V&cauthor_id=42920000)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-2 "Specialist Neonatology, Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates."), [Rachana Rd](https://pubmed.ncbi.nlm.nih.gov/?term=Rd+R&cauthor_id=42920000)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-3 "Department of Neonatology, Viswabharathi Medical College & General Hospital, Kurnool, Andhra Pradesh, India."), [Bijan Saha](https://pubmed.ncbi.nlm.nih.gov/?term=Saha+B&cauthor_id=42920000)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-4 "Department of Neonatology, Institute of Postgraduate Medical Education & Research, Kolkata, India."), [Srinivas Murki](https://pubmed.ncbi.nlm.nih.gov/?term=Murki+S&cauthor_id=42920000)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-5 "Department of Neonatology, Ankura Children's Hospital, L B Nagar, Hyderabad, Telangana, India."), [Vineet Bhandari](https://pubmed.ncbi.nlm.nih.gov/?term=Bhandari+V&cauthor_id=42920000)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-6 "Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, NJ, 08103, USA."), [Vikramaditya Dumpa](https://pubmed.ncbi.nlm.nih.gov/?term=Dumpa+V&cauthor_id=42920000)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42920000/#short-view-affiliation-7 "Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. VDumpa@uams.edu.") ### Affiliations * 1 Department of Neonatal-Perinatal Medicine, Mc Master University, Hamilton, ON, Canada. * 2 Specialist Neonatology, Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates. * 3 Department of Neonatology, Viswabharathi Medical College & General Hospital, Kurnool, Andhra Pradesh, India. * 4 Department of Neonatology, Institute of Postgraduate Medical Education & Research, Kolkata, India. * 5 Department of Neonatology, Ankura Children's Hospital, L B Nagar, Hyderabad, Telangana, India. * 6 Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, NJ, 08103, USA. * 7 Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. VDumpa@uams.edu. * PMID: **42920000** * DOI: [ 10.1007/s00431-026-07556-4 ](https://doi.org/10.1007/s00431-026-07556-4) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Continuous positive airway pressure (CPAP) is the standard initial therapy for respiratory distress syndrome (RDS) and associated with failure rates of up to 50% in extremely preterm infants. Nasal intermittent positive pressure ventilation (NIPPV) has demonstrated consistent benefits over CPAP in reducing respiratory failure and intubation. Nasal high-frequency oscillatory ventilation (nHFOV) has also shown reduced treatment failure compared with CPAP, particularly in extremely preterm infants. However, direct head-to-head comparisons between nHFOV and NIPPV as primary support are lacking, and available evidence from indirect comparisons has low certainty. Both NIPPV and nHFOV represent viable advanced non-invasive ventilation options beyond CPAP, each with distinct physiological mechanisms and evidence profiles. The current evidence base supports the use of both modalities in clinical practice, but robust head-to-head randomized controlled trials comparing nHFOV and NIPPV as primary respiratory support are urgently needed to guide optimal clinical decision-making. What is Known: • CPAP is the standard first-line support for RDS but fails in up to 50% of extremely preterm infants. • Both NIPPV and nHFOV reduce treatment failure and intubation compared with CPAP. What is New: • Neither NIPPV nor nHFOV has proven superior to the other, as direct comparisons are few and of low certainty. Head-to-head RCTs of nHFOV vs. NIPPV as primary support in extremely preterm infants are urgently needed. • Modality choice should also be guided by local expertise, available equipment, and gestational age. **Keywords:** Bronchopulmonary dysplasia; Nasal continuous positive airway pressure; Nasal high-frequency oscillatory ventilation; Nasal intermittent positive pressure ventilation; Preterm infant; Respiratory distress syndrome. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Competing interests: The authors declare no competing interests. ## References 1. 1. Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Lavizzari A et al (2025) European Consensus Guidelines on the Management of Respiratory Distress Syndrome. Neonatology 2026:1–26. - [DOI](https://doi.org/10.1159/000551062) 2. 1. Bancalari E, Jain D (2019) Bronchopulmonary Dysplasia: 50 Years after the Original Description. Neonatology 115(4):384–391. - [DOI](https://doi.org/10.1159/000497422) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30974430/) 3. 1. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S et al (2015) Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. JAMA 314(10):1039–1051. - [DOI](https://doi.org/10.1001/jama.2015.10244) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26348753/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/4787615/) 4. 1. McPherson C, Wambach JA (2018) Prevention and Treatment of Respiratory Distress Syndrome in Preterm Neonates. Neonatal Netw 37(3):169–177. - [DOI](https://doi.org/10.1891/0730-0832.37.3.169) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29789058/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/13160575/) 5. 1. Banerjee S, Fernandez R, Fox GF, Goss KCW, Mactier H, Reynolds P et al (2019) Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus. Pediatr Res 86(1):12–14. - [DOI](https://doi.org/10.1038/s41390-019-0344-5) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30780152/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/6760556/) Show all 78 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) ## MeSH terms * Continuous Positive Airway Pressure / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Continuous+Positive+Airway+Pressure%2Fmethods%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Continuous+Positive+Airway+Pressure) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * High-Frequency Ventilation* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22High-Frequency+Ventilation%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=High-Frequency+Ventilation) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * Infant, Newborn Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Infant%2C+Newborn%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Infant%2C+Newborn) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * Infant, Premature Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Infant%2C+Premature%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Infant%2C+Premature) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * Intermittent Positive-Pressure Ventilation* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Intermittent+Positive-Pressure+Ventilation%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Intermittent+Positive-Pressure+Ventilation) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) * Respiratory Distress Syndrome, Newborn* / therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Respiratory+Distress+Syndrome%2C+Newborn%2Ftherapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Respiratory+Distress+Syndrome%2C+Newborn) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920000/) ## Sup
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