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. 2022 Jul;11(7):1242-1250.
doi: 10.21037/tp-22-288.

Efficacy and safety of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in neonatal respiratory distress syndrome: a systematic review and meta-analysis

Hua Liu #  1 , Haiping Feng #  2 , Yao Zhang  1 , Li Zhang  1
Affiliations

Efficacy and safety of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in neonatal respiratory distress syndrome: a systematic review and meta-analysis

Hua Liu et al. Transl Pediatr. 2022 Jul.

Abstract

Background: The efficacies of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) in neonatal respiratory distress syndrome (RDS) are controversial. The reasons for controversy may be the selection bias of research objects and the small sample size.

Methods: Literature retrieval was performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang and China Science Digital Library (CSDL) databases. Inclusion criteria: (I) literatures involving subjects who were newborns with RDS; (II) studies that had established both experimental and control groups; (III) the intervention measures of the experimental and control groups were NIPPV and NCPAP, respectively; (IV) the results included the incidence of intubation, bronchopulmonary dysplasia (BPD), or mortality; and (V) randomized controlled trials (RCTs). The chi-square test was applied for heterogeneity test. Publication bias assessment was conducted by funnel plot and Egger's test. The revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2.0) was used to evaluate the risk of bias of the included RCT research.

Results: A total of 10 literatures were included for analysis, including 1,104 patients, 557 in the NIPPV group and 547 in the NCPAP group. Among the literatures, 2 literatures had low risk of bias, 2 literatures had high risk of bias, and the rest had uncertain risk of bias. Compared to NCPAP, NIPPV reduced the incidence of neonatal intubation in RDS [risk ratio (RR) =0.57, 95% confidence interval (CI): 0.46-0.71, Z=5.11, P<0.00001]. There was no statistically significant heterogeneity (P=0.13, I2=36%) or publication bias (P<0.05) among the studies. Compared with NCPAP, NIPPV reduced the incidence of BPD in RDS (RR =0.72, 95% CI: 0.57-0.91, Z=2.70, P=0.007). There was no statistically significant heterogeneity (P=0.10, I2=41%) or publication bias (P>0.05) among the studies. NIPPV reduced the neonatal mortality rate of RDS (RR =0.55, 95% CI: 0.31-0.97, Z=2.08, P=0.04). There was no statistically significant heterogeneity (P=0.20, I2=38%) or publication bias (P>0.05) among the studies.

Discussion: Compared with NCPAP, NIPPV can reduce the incidence of intubation, BPD, and mortality. The conclusions need to be confirmed via high-quality RCTs.

Keywords: Nasal intermittent positive pressure ventilation; nasal continuous positive airway pressure ventilation; respiratory distress syndrome.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-288/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Literature screening flow chart.
Figure 2
Figure 2
Forest map comparing the incidence of intubation between the NIPPV and NCPAP groups. NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
Figure 3
Figure 3
Funnel chart comparing the incidence of intubation between the NIPPV and NCPAP groups. SE, standard error; RR, risk ratio; NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
Figure 4
Figure 4
Forest map comparing the incidence of bronchopulmonary dysplasia between the NIPPV and NCPAP groups. NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
Figure 5
Figure 5
Funnel chart comparing the incidence of bronchopulmonary dysplasia incidence in the NIPPV and NCPAP groups. SE, standard error; RR, risk ratio; NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
Figure 6
Figure 6
Forest map comparing the mortality of the NIPPV and NCPAP groups. NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
Figure 7
Figure 7
Funnel chart comparing the mortality of the NIPPV and NCPAP groups. SE, standard error; RR, risk ratio; NIPPV, nasal intermittent positive pressure ventilation; NCPAP, nasal continuous positive airway pressure.
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