Non-invasive neurally-adjusted ventilatory assist in preterm infants with respiratory distress: a systematic review and meta-analysis

Abstract

Non-invasive neurally-adjusted ventilatory assist (NIV-NAVA) improves patient-ventilator synchrony and reduces treatment failure in preterm infants compared with nasal continuous positive airway pressure (NCPAP) and non-invasive positive-pressure ventilation (NIPPV). We conducted a systematic review and meta-analysis to assess the effectiveness of NIV-NAVA in preterm infants with respiratory distress. Four investigators independently assessed the eligibility of studies in CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PubMed, and WHO ICTRP databases, and extracted data. The included studies were randomized controlled trials (RCTs) comparing NIV-NAVA with other non-invasive ventilation modalities in preterm infants. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and four RCTs which examined 259 preterm infants were eligible to this study. In the subgroup of secondary use after extubation, NIV-NAVA reduces the risk of treatment failure compared with NCPAP/NIPPV (risk ratio 0.29; 95% confidence interval [0.10, 0.81], 2 RCTs, 96 infants, low certainty of the evidence). In the subgroup of primary use at birth, no statistically significant differences in treatment failure were observed (very low certainty of the evidence). Moreover, there were no significant differences in secondary outcomes. Therefore, NIV-NAVA may prevent treatment failure and the requirement of reintubation in preterm infants.