Background
Respiratory distress occurs in up to 7% of newborns, with respiratory support (RS) provided invasively via an endotracheal (ET) tube or non‐invasively via a nasal interface. Invasive ventilation increases the risk of lung injury and chronic lung disease (CLD). Using non‐invasive strategies, with or without minimally invasive surfactant, may reduce the need for mechanical ventilation and the risk of lung damage in newborn infants with respiratory distress.
Objectives
To evaluate the benefits and harms of nasal high‐frequency ventilation (nHFV) compared to invasive ventilation via an ET tube or other non‐invasive ventilation methods on morbidity and mortality in preterm and term infants with or at risk of respiratory distress.
Search methods
We searched CENTRAL, MEDLINE, Embase, CINAHL and three trial registries in April 2023.
Selection criteria
Randomised controlled trials (RCTs), cluster‐ or quasi‐RCTs of nHFV in newborn infants with respiratory distress compared to invasive or non‐invasive ventilation.
Data collection and analysis
Two authors independently selected the trials for inclusion, extracted data, assessed the risk of bias, and undertook GRADE assessment.
Main results
We identified 33 studies, mostly in low‐ to middle‐income settings, that investigated this therapy in 5068 preterm and 46 term infants.
nHFV compared to invasive respiratory therapy for initial RS
We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 0.67, 95% CI 0.20 to 2.18; 1 study, 80 infants) or the incidence of CLD (RR 0.38, 95% CI 0.09 to 1.59; 2 studies, 180 infants), both very low‐certainty. ET intubation, death or CLD, severe intraventricular haemorrhage (IVH) and neurodevelopmental disability (ND) were not reported.
nHFV vs nasal continuous positive airway pressure (nCPAP) used for initial RS
We are very uncertain whether nHFV reduces mortality before hospital discharge (RR 1.00, 95% CI 0.41 to 2.41; 4 studies, 531 infants; very low‐certainty). nHFV may reduce ET intubation (RR 0.52, 95% CI 0.33 to 0.82; 5 studies, 571 infants), but there may be little or no difference in CLD (RR 1.35, 95% CI 0.80 to 2.27; 4 studies, 481 infants); death or CLD (RR 2.50, 95% CI 0.52 to 12.01; 1 study, 68 participants); or severe IVH (RR 1.17, 95% CI 0.36 to 3.78; 4 studies, 531 infants), all low‐certainty evidence. ND was not reported.
nHFV vs nasal intermittent positive‐pressure ventilation (nIPPV) used for initial RS
nHFV may result in little to no difference in mortality before hospital discharge (RR 1.86, 95% CI 0.90 to 3.83; 2 studies, 84 infants; low‐certainty). nHFV may have little or no effect in reducing ET intubation (RR 1.33, 95% CI 0.76 to 2.34; 5 studies, 228 infants; low‐certainty). There may be a reduction in CLD (...
