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.

Abstract Objectives To systematically assess the beneficial effects of early NIPPV over NCPAP by performing a meta-analysis of current evidence. Data sources Medline, Embase, Web of science and the Cochrane Central Register of Randomized Controlled Trials(RCTs) was performed inception through 4 October 2019. Data Extraction and Synthesis Data were extracted independently by the three authors. The protocol of the systematic review was registered(number CRD42019147307). Pooled relative risk(RR) were estimated using the fixed-effects models, and the random-effects models were performed whenever more than 50% heterogeneity was shown. Heterogeneity was evaluated using the I2 method. Results 11 RCTs met the included criteria(n=1475). The meta-analysis demonstrated that, as compared with NCPAP, early NIPPV simultaneously reduced the incidences of IV (relative risk(RR):0.51, 95% confidence interval(CI): 0.42-0.62, P<0.00001) and BPD(RR: 0.51, 95%CI: 0.37-0.71, P<0.0001). Similarities were also shown in the subgroups of infants 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)), whose gestational age(GA)>30 weeks or birth weight(BW)>1,500g(IV(RR: 0.46, 95%CI: 0.33-0.63, P<0.00001) and BPD (RR:0.37,95%CI: 0.14-0.93, P=0.03)), and BPD and/or death(IV (RR: 0.51, 95%CI:0.40-0.67,P<0.00001) and BPD(RR: 0.46; 95%CI: 0.27- 0.81 P=0.007)). However, in the subgroups of infants whose GA≤30 weeks or BW≤1,500g, the incidences of IV and BPD were not simultaneously decreased. Conclusions Early NIPPV can be superior to NCPAP for simultaneously decreasing the incidences of IV and BPD in preterm infants with RDS. Early NIPPV as a better substitute for NCPAP may help to prevent BPD.