Efficacy of noninvasive respiratory support modes for primary respiratory support in preterm neonates with respiratory distress syndrome: Systematic review and network meta‐analysis

Abstract

Objectives: To compare the efficacy of different noninvasive respiratory support (NRS) modes for primary respiratory support of preterm infants with respiratory distress syndrome (RDS). Design: Systematic review and network meta-analysis using the Bayesian randomeffects approach. MEDLINE, EMBASE, and CENTRAL were searched. Interventions: High flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), bilevel CPAP (BiPAP), noninvasive positive pressure ventilation (NIPPV). Main Outcome Measures: Requirement of invasive mechanical ventilation (MV), any treatment failure. Results: A total of 35 studies including 4078 neonates were included. NIPPV was more effective in decreasing the requirement of MV than CPAP (risk ratios [95% credible interval]: 0.60 [0.44, 0.77]) and HFNC [0.66 (0.43, 0.97)]. Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP, HFNC, and CPAP were 0.95, 0.59, 0.32, and 0.13. For the outcome of treatment failure, both NIPPV and BiPAP were more efficacious compared to CPAP and HFNC (0.56 [0.44, 0.71] {NIPPV vs CPAP}, 0.69 [0.51, 0.93] {BiPAP vs CPAP}, 0.42 [0.30, 0.63] {NIPPV vs HFNC}, 0.53

Noninvasive Respiratory Support in Neonates: A Review of Current Evidence and Practices

“…Moreover, there is a significant decrease in nasal trauma [risk ratio (RR) 0.15; 95% confidence interval (CI) 0.01–0.60]. HFNC is shown to have increased risk of treatment failure compared to BiPAP (RR 1.90; 95% CI 1.24–2.81) and increased risk of treatment failure (RR 2.34 95% CI 1.59–3.33) and need for MV (RR 1.54; 95% CI 1.04–2.31) compared to NIPPV [ 5 ]. When used as a primary mode of respiratory support for RDS, HFNC was found to have higher failure rates compared to nCPAP (RR 1.86; 95% CI 1.53–2.25) [ 6 ].…”

“…Compared to NIMV, there is a significant increase in risk of treatment failure, need for MV, air leaks, and mortality. No difference in BPD is noted [ 5 ].…”

“…However, there was no difference in rates of air leaks, BPD, mortality, and nasal trauma. When compared to CPAP, NIPPV use results in a reduced risk of treatment failures (RR 0.56; 95% CI 0.44–0.71), MV (RR 0.60; 95% CI 0.44–0.77), air leaks (RR 0.54; 95% CI 0.30–0.87) and mortality (RR 0.60; 95% CI 0.37–0.89) [ 5 ].…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…However, a recent large network meta-analysis comparing different modes of noninvasive ventilation (35 studies and 4078 infants) used as primary respiratory support in preterm infants with RDS excluded the studies where the modalities of NIPPV and BiPAP/SiPAP were evaluated as similar interventions [57]. In this study, it was noted that NIPPV resulted in lesser incidence of BPD or death when compared to other modes of frequently used non-invasive ventilation.…”

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…NIV has previously been widely used in the eld of premature babies and newborns. Studies have con rmed that BiPAP and NCPAP can be used to treat neonatal respiratory failure, respiratory distress syndrome (RDS) and reduce the incidence of bronchopulmonary dysplasia [2,[5][6][7][8]. However, few studies have focused on the application of NIV in infants with CHD after extubation.…”