Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in neonates: a systematic review and meta-analysis.

Objective: To compare the efficacy and safety of Nasal intermittent positive pressure ventilation (NIPPV) and Nasal continuous positive airway pressure (nCPAP) in neonates.

Methods: Standard search strategy for the Cochrane Neonatal Review Group was performed. The participants were both preterm and term infants suffering from neonatal respiratory distress syndrome or experiencing apnea of prematurity.

Results: 14 eligible andomized controlled trials involving 1052 newborn infants were included. The study quality and evidence validity was defined as moderate. As compared with nCPAP, NIPPV significantly reduced the incidence of endotracheal ventilation OR 0.44, 95%CI 0.31 - 0.63, increased the successful rate of extubation (OR 0.15, 95%CI:0.08 - 0.31), and had a better outcome indicated by decreased death and/or bronchopulmonary dysplasia (OR 0.57, 95% CI:0.37 - 0.88). Moreover, NIPPV decreased the number of apneic episodes of prematurity (WMD-0.48, 95%CI 0.58 - 0.37), and marginally decreased the incidence of bronchopulmonary dysplasia (OR 0.63, 95%CI 0.39 - 1.00). No side effects specifically associated with NIPPV were reported.

Conclusion: NIPPV could be used to reduce endotracheal ventilation, increase successful extubation, decrease the rate of apnea of prematurity, and have better outcome indicated by fewer death and/or bronchopulmonary dysplasia in preterm and term newborn infants.