Non-invasive respiratory support in preterm infants as primary mode: a network meta-analysis

Area of Science:

• Neonatal respiratory support
• Evidence-based medicine

Background:

• Innovations in non-invasive respiratory support offer various modes for preterm infants.
• Understanding the comparative effectiveness of these modes is crucial for optimal patient care.

Purpose of the Study:

• To evaluate the benefits and harms of different non-invasive respiratory support modes used as primary support in preterm infants.
• To compare outcomes such as treatment failure, endotracheal ventilation, and chronic lung disease.

Main Methods:

• A systematic review and network meta-analysis of randomized, quasi-randomized, and cluster-randomized controlled trials.
• Included 61 studies involving 7554 preterm neonates.
• Assessed risk of bias and certainty of evidence using GRADE methodology.

Main Results:

• Nasal intermittent positive pressure ventilation (NIPPV) and non-invasive high-frequency oscillatory ventilation (NIHFV) may reduce treatment failure and endotracheal ventilation compared to nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC).
• Evidence for these comparisons is low to very low certainty.
• Little to no effect was observed on moderate-severe chronic lung disease (CLD) across different modes, with very uncertain evidence.

Conclusions:

• NIPPV and NIHFV show potential benefits in reducing treatment failure and the need for endotracheal ventilation in preterm infants.
• The low to very low certainty of evidence precludes firm conclusions and necessitates further high-quality research.
• Future studies should focus on infants <28 weeks' gestational age and ensure equivalent mean airway pressures for accurate comparisons.