Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 12:6:13.
doi: 10.3389/fped.2018.00013. eCollection 2018.

Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis

Prabhjot K Bedi  1 , Maria Luisa Castro-Codesal  1 , Robin Featherstone  2 , Mohammed M AlBalawi  3 , Bashar Alkhaledi  4 , Anita L Kozyrskyj  1   5 , Carlos Flores-Mir  6 , Joanna E MacLean  1   5
Affiliations

Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis

Prabhjot K Bedi et al. Front Pediatr. .

Abstract

Background: The use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants.

Methods: Ovid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library were systematically searched from January 1990 to July 2017. Studies on infants using long-term NIV outside of an acute care setting were included. Data were extracted on study design, population characteristics, and NIV outcomes.

Results: A total of 327 studies were full-text reviewed, with final inclusion of 60. Studies were distributed across airway (40%), neuromuscular (28%), central nervous system (10%), cardio-respiratory (2%), and multiple (20%) disease categories. Of the 18 airway studies reporting on NIV outcomes, 13 (72%) reported improvements in respiratory parameters. Of the 12 neuromuscular studies exclusively on spinal muscular atrophy type 1 (SMA1), six (50%) reported decreased hospitalizations and nine (75%) reported on mortality outcomes. Risk of bias was moderate to serious, and quality of the evidence was low to very low for all studies. Most studies had an observational design with no control group, limiting the potential for a meta-analysis.

Conclusion: The outcomes reported in studies differed by the disease category being studied. Studies on airway conditions showed improvements in respiratory parameters for infants using NIV. Studies on neuromuscular disorder, which were almost exclusively on SMA1, reported decreased hospitalizations and prolonged survival. Overall, it appears that NIV is an effective long-term therapy for infants. However, the high risk of bias and low quality of the available evidence limited strong conclusions.

Keywords: Pierre Robin sequence; bi-level positive airway pressure; central hypoventilation syndrome; continuous positive airway pressure; laryngo-tracheomalacia; obstructive sleep apnea; spinal muscular atrophy type 1.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram outlining the study selection process for the systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (15).
Figure 2
Figure 2
A meta-analysis on the effect of non-invasive ventilation (NIV) on the relative risk of mortality in infants with spinal muscular atrophy. The meta-analysis shows that the relative risk of mortality is significantly lower in infants using NIV compared to infants on supportive care. This decrease may be attributed to prolonged survival in infants using long-term NIV compared to supportive care.
See this image and copyright information in PMC

References

    1. Amin R, Sayal P, Syed F, Chaves A, Moraes TJ, MacLusky I. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol (2014) 49(8):816–24.10.1002/ppul.22868 - DOI - PubMed
    1. McDougall CM, Adderley RJ, Wensley DF, Seear MD. Long-term ventilation in children: longitudinal trends and outcomes. Arch Dis Child (2013) 98(9):660–5.10.1136/archdischild-2012-303062 - DOI - PubMed
    1. Amaddeo A, Moreau J, Frapin A, Khirani S, Felix O, Fernandez-Bolanos M, et al. Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: initiation criteria in real life. Pediatr Pulmonol (2016) 51(9):968–74.10.1002/ppul.23416 - DOI - PubMed
    1. Katz S, Selvadurai H, Keilty K, Mitchell M, MacLusky I. Outcome of non-invasive positive pressure ventilation in paediatric neuromuscular disease. Arch Dis Child (2004) 89(2):121–4.10.1136/adc.2002.018655 - DOI - PMC - PubMed
    1. Simonds AK, Ward S, Heather S, Bush A, Muntoni F. Outcome of paediatric domiciliary mask ventilation in neuromuscular and skeletal disease. Eur Respir J (2000) 16(3):476–81.10.1034/j.1399-3003.2000.016003476.x - DOI - PubMed

LinkOut - more resources