Nasal intermittent positive-pressure ventilation vs nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome: a systematic review and meta-analysis.

OBJECTIVE: To determine among preterm infants with respiratory distress syndrome whether the use of early nasal intermittent positive-pressure ventilation (NIPPV) vs nasal continuous positive airway pressure (NCPAP) decreases the need for invasive ventilation within the first 72 hours of life.

DATA SOURCES: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were searched, as well as abstracts from meetings of the Pediatric Academic Societies.

STUDY SELECTION: Randomized controlled trials involving infants with respiratory distress syndrome who received NIPPV vs NCPAP.

DATA EXTRACTION: Data were extracted on the use of NIPPV vs NCPAP. Also extracted were data on the need for invasive ventilation within the first 72 hours of life and the incidences of bronchopulmonary dysplasia, pneumothorax, necrotizing enterocolitis, and intraventricular hemorrhage, as well as the time to full feeds and the duration of hospital stay.

DATA SYNTHESIS: Three trials were included (n = 360). A significant decrease in the need for invasive ventilation was found in the NIPPV group (risk ratio, 0.60; 95% CI, 0.43-0.83). No difference between groups was found in the incidence of bronchopulmonary dysplasia (risk ratio, 0.56; 95% CI, 0.09-3.49). No differences in the other outcomes were observed between the 2 groups.

CONCLUSIONS: Among preterm infants with respiratory distress syndrome, NIPPV decreases the need for invasive ventilation within the first 72 hours of life compared with NCPAP. Trials are needed to assess whether NIPPV minimizes the occurrence of bronchopulmonary dysplasia and other comorbidities.