Abstract
Nasal high-frequency oscillatory ventilation (NHFOV) is a new respiratory support strategy despite lacking of enough evidence in preterm infants with respiratory distress syndrome (RDS). The aim of the present systematic review was to explore whether NHFOV reduced the intubation rate as compared with nasal continuous positive airway pressure (NCPAP) as the primary respiratory support strategies in preterm infants with RDS. Medline, the Cochrane library, the Cochrane Controlled Trials Register, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data Information Site were searched from inception to Jan 1, 2021(Prospero2019 CRD42019129316, date and name of registration: Apr 23,2019, The clinical effectiveness of NHFOV vs NCPAP for preterm babies with respiratory distress syndrome). Pooled data from clinically randomized controlled trials (RCTs) comparing NHFOV with NCPAP as the primary respiratory supporting strategies in preterm infants with RDS were performed using the fixed-effects models whenever no heterogeneity was shown. The primary outcome was intubation rate. Four randomized controlled trials involving 570 participants were included. Comparing with NCPAP, NHFOV resulted in less intubation (relative risk (RR) 0.44; 95% confidence interval (CI) 0.29-0.67, P = 0.0002), and heterogeneity was not found among the trials in the fixed-effects model (P = 0.78, I2 = 0%). Similar result also appeared in sensitivity analysis after excluding one study with significant difference (RR 0.44; 95% CI 0.25-0.78, P = 0.005) (P = 0.58, I2 = 0%).Conclusion: NHFOV decreased the intubation rate as compared with NCPAP as primary respiratory supporting strategies in preterm infants suffering from RDS. Future research should assess whether NHFOV can reduce the incidence of bronchopulmonary dysplasia (BPD) and intubation rate in preterm infants with BPD. Fund by Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197), and "guan'ai" preterm Study Program of Renze Foundation of Beijing(K022). What is Known: • Nasal high-frequency oscillatory ventilation (NHFOV) has been described to be another advanced version of nasal continuous positive airway pressure (NCPAP). However, its beneficial effects among different studies as the primary modes in the early life of preterm infants with respiratory distress syndrome (RDS) were inconsistent. What is New: • Comparing with NCPAP, NHFOV decreases the risk of intubation as a primary respiratory supporting strategy in early life for preterm infants suffering from RDS.
Highlights
Invasive ventilation(IV) is a key procedure to reduce respiratory mortality and morbidity in preterm infants with respiratory distress syndrome(RDS)
Nasal high-frequency oscillatory ventilation (NHFOV) is superior to nasal continuous positive airway pressure (NCPAP) in decreasing the risk of intubation as a primary respiratory supporting strategies in preterm infants suffering from RDS
The meta-analysis indicated that NHFOV resulted in less intubation rate(RR:0.47; 95% CI:0.31-0.70, P=0.0002) as compared with NCPAP and heterogeneity was not found among the four trials in the fixed effects model (P=0.69, I2=0%) (Fig. 2)
Summary
Invasive ventilation(IV) is a key procedure to reduce respiratory mortality and morbidity in preterm infants with respiratory distress syndrome(RDS). It inhibits normal respiratory physiological process and is associated with the increased risks of bronchopulmonary dysplasia (BPD),[1] re-hospitalization and brain injury among the survivors.[2,3,4] How to avoid IV in early life is a critical procedure to reduce respiratory mortality and morbidity. Nasal continuous positive airway pressure(NCPAP) remains one widely used way of the noninvasive ventilation modes to avoid intubation in preterm infants. Early use of NIPPV was not shown beneficial effects for decreasing the need for intubation as compared with NCPAP alone in preterm infants with RDS. [5, 6]
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