I read with great interest the article by Bhandari et al, who discuss the feasibility of nasal intermittent positive pressure ventilation (NIPPV) to support premature infants. Their article brings forward a modality for respiratory support of premature infants that is less invasive than mechanical ventilation (MV). Although it is important to demonstrate that the avoidance of intubation and the use of NIPPV can result in less morbidity, it is important to recognize that avoidance of unneeded intermittent ventilation, whether via nasal prongs or an endotracheal tube, could be more beneficial. The use of NIPPV can be used as a second line of support to premature infants who do not respond positively to less-invasive treatments.

Years ago, MV was used as the first-line, and maybe the only available, option for respiratory support of premature infants with hyaline membrane disease. Although MV has been widely used, research has shown a...

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