Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure as primary respiratory support strategies for respiratory distress syndrome in preterm infants: a systematic review and meta-analysis

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, I-2 =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,I-2 =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).

Automated summary

NHFOV reduces the intubation rate compared to NCPAP in preterm infants with RDS. Future research should evaluate if NHFOV can lower the incidence of bronchopulmonary dysplasia and intubation rate in preterm infants with BPD.