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Review
. 2023 Dec 18;10(12):1935.
doi: 10.3390/children10121935.

Noninvasive Neurally Adjusted Ventilation versus Nasal Continuous or Intermittent Positive Airway Pressure for Preterm Infants: A Systematic Review and Meta-Analysis

Mohammed Bhader  1   2 , Mohammed Al-Hindi  1   2   3 , Abdullah Ghaddaf  1   2 , Anas Alamoudi  1   2 , Amal Abualola  1   2 , Renad Kalantan  1   2 , Norah AlKhulifi  1   2 , Ibrahim Halawani  4 , Mansour Al-Qurashi  1   2   3
Affiliations
Review

Noninvasive Neurally Adjusted Ventilation versus Nasal Continuous or Intermittent Positive Airway Pressure for Preterm Infants: A Systematic Review and Meta-Analysis

Mohammed Bhader et al. Children (Basel). .

Abstract

The noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is a newly developed noninvasive ventilation technique with promising clinical and ventilatory outcomes for preterm infants. This systematic review and meta-analysis aimed to investigate whether NIV-NAVA has better clinical and ventilatory outcomes than nasal continuous airway pressure (NCPAP) or noninvasive positive pressure ventilation (NIPP) on premature infants. MEDLINE, Embase, and CENTRAL were searched, and randomized controlled trials (RCTs) that compared NIV-NAVA with NCPAP or NIPP for preterm infants (gestational age: <37 weeks) were included. We evaluated the following outcomes in the neonatal intensive care unit: the desaturation rate, failure of noninvasive modality requiring intubation when received as the primary mode or the need for re-intubation after extubation from mechanical ventilation in the secondary mode (weaning), length of stay, and fraction of inspired oxygen. The mean difference and risk ratio were used to represent continuous and dichotomous outcomes, respectively. We included nine RCTs involving 339 preterm infants overall. NIV-NAVA showed similar clinical and ventilatory outcomes to NCPAP or NIPP, except for the maximum diaphragmatic electrical activity. The rate of failure of the noninvasive modality was not statistically different between NIV-NAVA and NCPAP. The pooled estimates for the maximum electrical activity were significantly reduced in NIV-NAVA compared with those in NIPP. The findings suggest that NIV-NAVA may be as safe and effective as NCPAP and NIPP for preterm neonates, particularly those who may not tolerate these alternative noninvasive methods. However, further trials are recommended for greater evidence.

Keywords: intermittent positive airway pressure ventilation (NIPP); nasal continuous or positive airway pressure (NCPAP); noninvasive neurally adjusted ventilatory assist (NIV-NAVA); noninvasive ventilation; preterm infants; respiratory distress syndrome (RDS); systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias graph of the included studies.
Figure 3
Figure 3
Risk of bias summary of the included studies [18,23,24,25,31,32,33,34,35].
Figure 4
Figure 4
Forest plot of comparison between neurally adjusted ventilatory assist (NIV-NAVA) versus nasal continuous airway pressure (NCPAP), outcome “Noninvasive Modality failure (need for intubation when used as primary mode, and need for re-intubation when used as weaning)” [24,31,33,35].
Figure 5
Figure 5
Comparison between NIV-NAVA and NCPAP; outcome: “Need for surfactant therapy” [24,31,35].
Figure 6
Figure 6
Forest plot of comparison between NIV-NAVA and NIPP; outcome: “Need for surfactant Therapy” [32,34].
Figure 7
Figure 7
Forest plot of comparison between NIV-NAVA and NCPAP; outcome: “Pneumothorax” [24,31,35].
Figure 8
Figure 8
Forest plot of comparison between NIV-NAVA and NCPAP; outcome: “Bronchopulmonary dysplasia (BPD)” [33,35].
Figure 9
Figure 9
Forest plot of comparison between NIV-NAVA and NCPAP; outcome: “Length of hospital stay” [24,33].
Figure 10
Figure 10
Forest plot of comparison between NIV-NAVA and NCPAP; outcome: “Duration of invasive ventilation” [24,31,35].
Figure 11
Figure 11
Forest plot of comparison between NIV-NAVA and NIPP; outcome: “Maximum Edi (uV)” [18,25,34].
Figure 12
Figure 12
Forest plot of comparison between NIV-NAVA and NIPP; outcome: “Minimum Edi (uV)” [18,25,34].
Figure 13
Figure 13
Forest plot of comparison between NIV-NAVA and NIPP; outcome: “Swing Edi (uV)” [18,34].
See this image and copyright information in PMC

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