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Noninvasive neurally adjusted assisted ventilation as weaning mode in extremely preterm infants: a meta-analysis and systematic review


      Background: The long duration of IMV for premature infants connected to adverse clinical complications. It has been proven that noninvasive ventilation (NIV) improved the weaning process. Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is a new type of NIV, and its effects on weaning are a subject of debate in clinical practice. To compare NIV-NAVA and conventional NIV as weaning modes in preterm neonates, this article was preformed. Methods: Cochrane Library, Embase, PubMed, Scopus, and Web of Science were comprehensively searched. Published reports were screened and assessed based on predetermined inclusion and exclusion criteria. The Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale were used to evaluate the quality of reports and bias. Review Manager 5.3 was used in the meta-analysis. Trial sequential analysis (TSA) was used to avoid false-positive or false-negative conclusions caused by constantly updated data. Results: Six studies ( n = 265) were included. Preterm infants who underwent NIV-NAVA had a lower weaning failure comparing with conventional NIV (risk ratio 0.37, 95% confidence interval 0.21–0.67, p = 0.001). In TSA the cumulative Z‑curve crossed monitoring boundary for the benefit of NIV-NAVA indicated that NIV-NAVA might improve extubation failure. With respect to the rates of related adverse clinical events, there was no statistically significant difference between the NIV-NAVA group and the conventional NIV group in forest plots. Conclusion: The current meta-analysis suggests that NIV-NAVA may reduce the rate of extubation failure compared to conventional NIV.