Early nasal intermittent positive pressure versus nasal continuous
positive airway pressure for preterm infants with respiratory distress
syndrome: a systematic review and meta-analysis
Abstract
Background Nasal intermittent positive pressure ventilation (NIPPV) and
nasal continuous positive airway pressure (NCPAP) are two widely used
ways of noninvasive ventilation. Whether or not early NIPPV
simultaneously reducing the incidences of invasive ventilation(IV) and
BPD as compared with NCPAP in preterm infants with RDS remains unclear.
The present study aims to systematically assess the beneficial effects
between NIPPV and NCPAP. Methods: A search of Medline, Embase, Web of
Science and the Cochrane Central Register of Controlled Trials(from 1980
to Feb 2022) was performed, and randomized controlled trials(RCTs)
comparing early NIPPV with NCPAP in preterm infants with RDS were
included. The primary outcome was simultaneous incidences of IV and BPD.
Results: Meta-analysis of 13 RCTs (n = 1681) demonstrated that, compared
with NCPAP, early NIPPV concurrently reduced the incidences of IV
[relative risk (RR):0.52, 95% confidence interval (CI) 0.43, 0.63, P
< 0.00001] and BPD (RR: 0.51, 95%CI 0.37, 0.71, P
< 0.0001). Similarities were also shown in the subgroups
receiving surfactant [IV (RR:0.59, 95%CI 0.45, 0.77, P = 0.0001) and
BPD (RR: 0.57, 95%CI 0.37, 0.87, P = 0.009) ], birth weight(BW) ≤
1,500g [IV (P < 0.0001) and BPD (P = 0.004) ] and
excluding RCTs with significant difference referring to IV (P = 0.0004)
and BPD (P = 0.02) . Conclusions: Early NIPPV could be superior to NCPAP
in concurrently decreasing the incidences of IV and BPD in preterm
infants with RDS, especially in the infants receiving surfactant and
whose BW ≤ 1,500g.