Investigation of the clinical outcomes of respiratory support provided by nasal high-frequency oscillatory ventilation (NHFOV) and nasal intermittent positive pressure ventilation (NIPPV) after extubation in preterm neonates born before 34 weeks receiving invasive respiratory support and its effect on brain oxygenation with near-infrared spectroscopy (NIRS)

Our study aims to evaluate the effects of NHFOV and NIPPV on extubation success and reintubation rates in preterm neonates born before 34 weeks. Secondary objectives include assessing post-extubation brain oxygenation using the non-invasive NIRS device and determining complication rates associated with NHFOV and NIPPV. This prospective, randomized controlled study was conducted in the Neonatal Intensive Care Unit of SANKO University Faculty of Medicine between January and December 2024. A total of 80 infants were included. Extubation was considered successful if the infant was not reintubated within 72 hours post-extubation. Patients were followed until PM 36 weeks or discharge. Brain oxygenation was assessed by placing an oximeter probe on the forehead before and after extubation. Cerebral regional oxygen saturation (SrSO₂) values from the NIRS device and SpO₂ readings from pulse oximetry were recorded every 5 minutes for 30 minutes. Cerebral fractional oxygen extraction (SFOE) was calculated for each interval and compared. The reintubation rate was significantly lower in the NHFOV group than in NIPPV (p ≤ 0.01). Reintubation duration was 27.0 hours (3.0-62.0) in NHFOV and 10.5 hours (5.0-16.0) in NIPPV (p ≤ 0,01). More infants in the NIPPV group required non-invasive mechanical ventilation at PM 36 weeks. No significant difference was observed in hospital stay between groups. SpO₂, cerebral FOE, and cerebral rSO₂ values before and after extubation were comparable (p ≥ 0.96). NHFOV appears to be a safe secondary ventilation mode, reducing reintubation rates without increasing complications. Extubation success was higher in NHFOV. However, as no significant effect on brain oxygenation or PM 36-week outcomes was observed, larger studies are needed. Keywords: Extubation success, NHFOV, NIPPV, cerebral oxygenation, NIRS.