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Efficacy of non-invasive respiratory support modes for primary respiratory support in preterm neonates with Respiratory Distress Syndrome: Systematic review and network meta-analysis.
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  • Viraraghavan Ramaswamy,
  • Kiran More,
  • Charles Christoph Roehr,
  • Prathik Bandya,
  • Sushma Nangia
Viraraghavan Ramaswamy
Oxford University Hospitals NHS Foundation Trust
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Kiran More
Sidra Medicine
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Charles Christoph Roehr
Oxford University Hospitals NHS Foundation Trust
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Prathik Bandya
Indira Gandhi Institute of Child Health
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Sushma Nangia
Lady Hardinge Medical College & Kalawati Saran Children's Hospital
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Abstract

Objectives: To compare the efficacy of different non-invasive respiratory support modes for primary respiratory support of preterm infants with Respiratory Distress Syndrome (RDS). Design: Systematic review and network meta-analysis using the Bayesian random effects approach. MEDLINE, EMBASE and CENTRAL were searched. Interventions : HFNC (High Flow Nasal Cannula), CPAP (Continuous Positive Airway Pressure), BiPAP (Bilevel CPAP), NIPPV (Non Invasive Positive Pressure Ventilation). Main outcome measures: Requirement of invasive mechanical ventilation, any treatment failure. Results: 34 studies including 3994 patients were included. NIPPV was more effective in decreasing the requirement of mechanical ventilation than CPAP {RR [95% Credible Interval (CrI)] - 0.60 (0.44, 0.79)}and HFNC [0.66 (0.43, 0.99)]. Surface under the cumulative ranking curve (SUCRA) for NIPPV, BiPAP, HFNC and CPAP were 0.94, 0.59, 0.32 and 0.13. For the outcome of treatment failure, both NIPPV and BiPAP were more efficacious compared to CPAP and HFNC {0.56 (0.44, 0.71) [NIPPV vs CPAP], 0.69 (0.51, 0.93) [BiPAP vs CPAP], 0.42 (0.30, 0.63) [NIPPV vs HFNC], 0.53 (0.35, 0.81) [BiPAP vs HFNC]}. The SUCRA for NIPPV, BiPAP, CPAP and HFNC were 0.96, 0.70, 0.32 and 0.01. NIPPV was associated with a reduced risk of air leak compared to BiPAP and CPAP [0.36 (0.16, 0.73); 0.54(0.30, 0.87), respectively]. NIPPV resulted in lesser incidence of BPD or mortality when compared to CPAP [0.74 (0.52, 0.98)]. Nasal injury was lesser with HFNC compared to CPAP [0.15 (0.01, 0.60)]. Conclusions: Most effective primary mode of non-invasive respiratory support in preterm neonates with RDS was NIPPV.

Peer review status:ACCEPTED

06 Jun 2020Submitted to Pediatric Pulmonology
08 Jun 2020Submission Checks Completed
08 Jun 2020Assigned to Editor
10 Jun 2020Reviewer(s) Assigned
30 Jun 2020Review(s) Completed, Editorial Evaluation Pending
04 Jul 2020Editorial Decision: Revise Major
15 Jul 20201st Revision Received
16 Jul 2020Submission Checks Completed
16 Jul 2020Assigned to Editor
16 Jul 2020Reviewer(s) Assigned
03 Aug 2020Review(s) Completed, Editorial Evaluation Pending
05 Aug 2020Editorial Decision: Accept