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Objective To investigate the effect of nasal continuous positive airway pressure (NCPAP) given with nasal masks (NM) compared with binasal prongs (BNP) on the incidence of intubation within 72 hours in preterm infants (primary outcome) via meta‐analysis of clinical studies. Data Sources We searched for randomized clinical trials (RCTs) or quasi‐RCTs in Medline, PubMed, and Web of Science from inception through 4 December 2019. Data Extraction/Synthesis Two independent co‐authors extracting data performed the meta‐analysis using a fixed‐effect model to yield pooled relative risk (RR) and its 95% confidence interval (CI) for each outcome. We used Cochrane GRADE to evaluate the evidence quality. Results Eleven RCTs met the inclusion criteria. The meta‐analysis showed NCPAP provided via NM significantly reduced the rate of intubation within 72 hours (RR, 0.72; 95% CI, 0.58‐0.90; nine studies; GRADE‐moderate) and nasal trauma (RR, 0.64; 95% CI, 0.55‐0.74; GRADE‐low) compared with NCPAP provided via BNP. Also, NCPAP via NM significantly reduced surfactant treatment (RR, 0.85; 95% CI, 0.74‐0.97; GRADE‐very low) and bronchopulmonary dysplasia (RR, 0.47; 95% CI, 0.23‐0.95; GRADE‐low) compared with BNP in a setting where NCPAP was used as the primary support in respiratory distress syndrome. No statistically significant differences were noted between groups in secondary outcomes except increased NCPAP duration when NCPAP given with NM compared with BNP (mean difference [days], 1.78; 95% CI, 1.67‐1.89; GRADE‐low). Conclusion Among premature infants, NCPAP provided with NM is more effective in preventing intubation and mechanical ventilation within 72 hours of initiating the support compared with NCPAP provided with BNP.

Objective To evaluate the physiological impact of high CPAP (≥9 cmH 2 O) vs. NIPPV at equivalent mean airway pressures. Study design In this cross-over study, preterm neonates on high CPAP or NIPPV were placed on the alternate mode. After 30 min, left and right ventricular cardiac output and work of breathing indices were assessed, following which patients were placed back on the original mode and a similar procedure ensued. Results Fifteen infants with mean (SD) postmenstrual age 32.7 (3.0) weeks, and weight 1569 (564) grams were included. No differences in LVO [320 (63) vs. 331 (86) mL/kg/min, P = 0.46] or RVO [420 (135) vs. 437 (141) mL/kg/min, P = 0.19] were noted during high CPAP vs. NIPPV, along with no differences in work of breathing indices. Conclusion High CPAP pressures did not adversely impact cardiac output or work of breathing compared to NIPPV at equivalent mean airway pressure.

Objective The aim of this study was to compare outcomes following receipt of high continuous positive airway pressure (CPAP) versus nasal intermittent positive pressure ventilation (NIPPV) in extremely preterm neonates. Study Design We retrospectively compared outcomes of preterm neonates (22–28 weeks' gestation) following their first episode of either high CPAP (≥ 9 cmH2O) or NIPPV. Primary outcome was failure of high CPAP or NIPPV within 7 days, as determined by either need for intubation or use of an alternate noninvasive mode. Results During the 3-year study period, 53 infants received high CPAP, while 119 patients received NIPPV. There were no differences in the primary outcome (adjusted odds ratio 1.21; 95% confidence interval 0.49–3.01). The use of alternate mode of noninvasive support was higher with the use of high CPAP but no other outcome differences were noted. Conclusion Based on this cohort, there was no difference in incidence of failure between high CPAP and NIPPV, although infants receiving high CPAP were more likely to require an alternate mode of noninvasive support. Key Points