Aims: To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute bronchiolitis.Methods: Retrospective review of two paediatric intensive care units (PICU) databases and case notes; one PICU offered NPV.Results: Fifty two infants with bronchiolitis related apnoea were admitted to the two PICUs (31 to the NPV centre).There were no significant differences between infants in the two centres in age and weight on admission, gestational age at birth, birth weight, history of apnoea of prematurity or chronic lung disease, days ill before referral, respiratory syncytial virus status, oxygen requirement before support, and numbers retrieved from secondary care centres.Respiratory support was provided to all 31 infants in the NPV centre (23 NPV, 8 PPV), and 19/21 in the non-NPV centre (18 PPV, 1 CPAP); the NPV centre had lower rates of endotracheal intubation rates (8/31 v 18/21 ), shorter durations of stay (median 2 v 7 days), and less use of sedation (16/31 v 18/21 ).In the two years after the NPV centre discontinued use of NPV, 14/ 17 (82%) referred cases were intubated, with a median PICU stay of 7.5 days.Conclusions: The use of NPV was associated with a reduced rate of endotracheal intubation, and shorter PICU stay.A prospective randomised controlled trial of the use of NPV in the treatment of bronchiolitis related apnoea is warranted. Aims: To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute Bronchiolitis. Methods: Retrospective review of two pediatric intensive care units (PICU) databases and case notes ; one PICU offered NPV. Results: Fifty two infants with bronchiolitis related apnoea were admitted to the two PICUs (31 to the NPV center). There were no significant differences between infants in the two centers in age and weight on admission, gestational age at birth, birth weight, history of apnoea of ​​prematurity or chronic lung disease, days ill before referral, respiratory syncytial virus status, oxygen requirement before support, and numbers retrieved from secondary care centers. Respiratory support was provided to all 31 infants in the NPV center (23 NPV, 8 PPV), and 19/21 in the non-NPV center (18 PPV, 1 CPAP); the NPV center had lower rates of endotracheal intubation rates (8/31 v 18/2 Shorter durations of stay (median 2 v 7 days), and less use of sedation (16/31 v 18/21) .In the two years after the NPV center discontinued use of NPV, 14/17 (82%) referred cases were intubated, with a median PICU stay of 7.5 days. Conclusions: The use of NPV was associated with a reduced rate of endotracheal intubation, and shorter PICU stay. A prospective randomized controlled trial of the use of NPV in the treatment of bronchiolitis related apnoea is warranted.