Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

Abstract

nIPPV compared with nCPAP reduced the need for endotracheal intubation and invasive mechanical ventilation in premature infants with RDS.

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

“…Also, more recent studies that were published after Isayama et al's 10 metaanalysis were included in the present analysis. 39,40,[52][53][54] The other reason might be the differences in the gestational ages of the neonates enrolled in Isayama et al 10 study and our study. While Isayama et al 10 included studies that have enrolled smaller neonates (mean gestational age of 29 weeks), ours had included neonates with a mean gestational of 31 weeks.…”

“…The electronic database search revealed a total of 9032 studies. After screening for suitability, 35 studies were included in the final synthesis 23‐57 . The PRISMA flow diagram is depicted in Figure 1.…”

“…Also, this was an NMA where apart from the direct synthesis, the indirect evidence also contributed toward the overall effect estimate. It is evident from the included studies that the peak inspiratory pressure and hence the mean airway pressure (MAP) that was delivered with NIPPV was much higher than the positive end‐expiratory pressure generated with CPAP 41‐54 . This might be one of the reasons for NIPPV being more effective than CPAP.…”

“…Overall, 13 studies 25,28,30,32,33,37,[40][41][42][43][44]51,57 were regarded as having a low risk of bias, the remaining studies were found to have variable degrees of risk of bias. Fourteen studies had high risk of bias 27,[34][35][36]38,45,[47][48][49][50]52,[54][55][56] with issues in randomisation and/or allocation concealment. Eight studies 23,24,26,29,31,39,46,53 had unclear bias as methodology was not described very well.…”

“…It is evident from the included studies that the peak inspiratory pressure and hence the mean airway pressure (MAP) that was delivered with NIPPV was much higher than the positive end-expiratory pressure generated with CPAP. [41][42][43][44][45][46][47][48][49][50][51][52][53][54] This might be one of the reasons for NIPPV being more effective than CPAP. The fact that the incidence of air leak, as well as that of the combined outcome of BPD or mortality, was much lesser with NIPPV when compared to CPAP might suggest that the use of a relatively higher MAP with NIPPV is not deleterious.…”