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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

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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.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

BPD:

Bronchopulmonary dysplasia

CMV:

Conventional mechanical ventilation

IV:

Invasive ventilation

IVH:

Intraventricular hemorrhage

NEC:

Necrotizing enterocolitis

NCPAP:

Nasal continuous positive airway pressure

NIPPV:

Nasal intermittent positive pressure ventilation

NHFOV:

Nasal high-frequency oscillatory ventilation

PVL:

Periventricular leukomalacia

ROP:

Retinopathy of prematurity

RDS:

Respiratory distress syndrome

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Funding

Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197) and “guan’ai” preterm Study Program of Renze Foundation of Beijing (K022).

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Author notes

  1. Chen Long and Shi Yuan equal contribution to the present study.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China

    Jie Li

  2. Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, 400014, Chongqing, People’s Republic of China

    Long Chen & Yuan Shi

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Contributions

Li Jie: Dr. Li accomplished the article-extracting and data analysis, drafted the initial manuscript, and reviewed the manuscript. Chen Long: Dr. Chen conceptualized and designed the study, accomplished the article-extracting and data analysis, and revised the initial manuscript. Shi Yuan: Dr. Shi conceptualized and designed the study, accomplished the article-extracting and data analysis, and critically reviewed the manuscript for important intellectual content. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Yuan Shi.

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Communicated by Daniele De Luca

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Li, J., Chen, L. & Shi, Y. 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. Eur J Pediatr 181, 215–223 (2022). https://doi.org/10.1007/s00431-021-04190-0

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