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Ventilación nasal con presión positiva intermitente (VNPPI) precoz versus presión positiva nasal continua de las vías respiratorias (PPNCVR) en lactantes prematuros después de la extubación

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DOI:
https://doi.org/10.1002/14651858.CD003212.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 01 February 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Neonatal Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Brigitte Lemyre

    Correspondence to: Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Canada

    [email protected]

  • Peter G Davis

    The University of Melbourne, Melbourne, Australia

  • Antonio G De Paoli

    Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia

  • Haresh Kirpalani

    Department of Pediatrics, University of Pennsylvania School of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University, Philadelphia, USA

Contributions of authors

PGD and BL prepared the protocol for this review.

AGD and HK provided additional material for the Background section.

BL updated the literature search, made independent quality assessments and extracted data before comparing results and resolving differences for this update.

All review authors participated in data analysis and interpretation of results for this updated review.

Sources of support

Internal sources

  • Royal Women's Hospital, Melbourne, Australia.

  • Murdoch Children's Research Institute, Melbourne, Australia.

  • University of Melbourne, Australia.

  • Royal Hobart Hospital, Australia.

  • University of Tasmania, Australia.

External sources

  • National Health and Medical Research Council, Australia.

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C.

  • National Institute for Health Research, UK.

    Editorial support for Cochrane Neonatal has been funded with funds from a UK National Institute of Health Research Grant (NIHR) Cochrane Programme Grant (13/89/12). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.

Declarations of interest

Review authors have declared no conflicts of interest.

Acknowledgements

The review authors acknowledge the generosity of Drs Friedlich, Barrington and Bhandari, who supplied 'preprints' of their manuscripts and additional information for this review. Review authors also acknowledge the generosity of the steering committee of Kirpalani 2013, which provided further data for analysis.

Version history

Published

Title

Stage

Authors

Version

2023 Jul 27

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation

Review

Brigitte Lemyre, Marc-Olivier Deguise, Paige Benson, Haresh Kirpalani, Antonio G De Paoli, Peter G Davis

https://doi.org/10.1002/14651858.CD003212.pub4

2017 Feb 01

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation

Review

Brigitte Lemyre, Peter G Davis, Antonio G De Paoli, Haresh Kirpalani

https://doi.org/10.1002/14651858.CD003212.pub3

2014 Sep 04

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation

Review

Brigitte Lemyre, Peter G Davis, Antonio G De Paoli, Haresh Kirpalani

https://doi.org/10.1002/14651858.CD003212.pub2

2001 Jul 23

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation

Review

Peter G Davis, Brigitte Lemyre, Antonio G De Paoli

https://doi.org/10.1002/14651858.CD003212

Differences between protocol and review

We added the methods and plan for 'Summary of findings' tables and GRADE recommendations, which were not included in the original protocol, nor in the previously published review.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram: review update.
Figures and Tables -
Figure 1

Study flow diagram: review update.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 1 Respiratory failure post extubation.
Figures and Tables -
Analysis 1.1

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 1 Respiratory failure post extubation.

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 2 Endotracheal re‐intubation.
Figures and Tables -
Analysis 1.2

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 2 Endotracheal re‐intubation.

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 3 Post hoc analysis (high‐quality studies): respiratory failure post extubation.
Figures and Tables -
Analysis 1.3

Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 3 Post hoc analysis (high‐quality studies): respiratory failure post extubation.

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 1 Abdominal distension leading to cessation of feeds.
Figures and Tables -
Analysis 2.1

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 1 Abdominal distension leading to cessation of feeds.

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 2 Gastrointestinal perforation.
Figures and Tables -
Analysis 2.2

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 2 Gastrointestinal perforation.

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 3 Necrotising enterocolitis.
Figures and Tables -
Analysis 2.3

Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 3 Necrotising enterocolitis.

Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 1 Chronic lung disease (oxygen supplementation at 36 weeks).
Figures and Tables -
Analysis 3.1

Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 1 Chronic lung disease (oxygen supplementation at 36 weeks).

Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 2 Air leaks.
Figures and Tables -
Analysis 3.2

Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 2 Air leaks.

Comparison 4 NIPPV versus NCPAP and mortality, Outcome 1 Death before discharge.
Figures and Tables -
Analysis 4.1

Comparison 4 NIPPV versus NCPAP and mortality, Outcome 1 Death before discharge.

Comparison 5 NIPPV versus NCPAP and duration of hospital admission, Outcome 1 Duration of hospital admission (days).
Figures and Tables -
Analysis 5.1

Comparison 5 NIPPV versus NCPAP and duration of hospital admission, Outcome 1 Duration of hospital admission (days).

Comparison 6 NIPPV versus NCPAP and apnoea, Outcome 1 Rates of apnoea (episodes/24 h).
Figures and Tables -
Analysis 6.1

Comparison 6 NIPPV versus NCPAP and apnoea, Outcome 1 Rates of apnoea (episodes/24 h).

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 1 Respiratory failure post extubation.
Figures and Tables -
Analysis 7.1

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 1 Respiratory failure post extubation.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 2 Endotracheal re‐intubation during the week post extubation.
Figures and Tables -
Analysis 7.2

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 2 Endotracheal re‐intubation during the week post extubation.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 3 Abdominal distension requiring cessation of feeds.
Figures and Tables -
Analysis 7.3

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 3 Abdominal distension requiring cessation of feeds.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 4 Gastrointestinal perforation.
Figures and Tables -
Analysis 7.4

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 4 Gastrointestinal perforation.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 5 Necrotising enterocolitis.
Figures and Tables -
Analysis 7.5

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 5 Necrotising enterocolitis.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 6 Chronic lung disease (oxygen supplementation at 36 weeks).
Figures and Tables -
Analysis 7.6

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 6 Chronic lung disease (oxygen supplementation at 36 weeks).

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 7 Pulmonary air leak.
Figures and Tables -
Analysis 7.7

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 7 Pulmonary air leak.

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 8 Rates of apnoea (episodes/24 h).
Figures and Tables -
Analysis 7.8

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 8 Rates of apnoea (episodes/24 h).

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 9 Duration of hospitalisation (days).
Figures and Tables -
Analysis 7.9

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 9 Duration of hospitalisation (days).

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 10 Death before discharge.
Figures and Tables -
Analysis 7.10

Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 10 Death before discharge.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 1 Respiratory failure post extubation.
Figures and Tables -
Analysis 8.1

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 1 Respiratory failure post extubation.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 2 Endotracheal re‐intubation during the week post extubation.
Figures and Tables -
Analysis 8.2

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 2 Endotracheal re‐intubation during the week post extubation.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 3 Abdominal distension requiring cessation of feeds.
Figures and Tables -
Analysis 8.3

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 3 Abdominal distension requiring cessation of feeds.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 4 Gastrointestinal perforation.
Figures and Tables -
Analysis 8.4

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 4 Gastrointestinal perforation.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 5 Necrotising enterocolitis.
Figures and Tables -
Analysis 8.5

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 5 Necrotising enterocolitis.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 6 Chronic lung disease (oxygen supplementation at 36 weeks).
Figures and Tables -
Analysis 8.6

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 6 Chronic lung disease (oxygen supplementation at 36 weeks).

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 7 Pulmonary air leak.
Figures and Tables -
Analysis 8.7

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 7 Pulmonary air leak.

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 8 Rates of apnoea (episodes/24 h).
Figures and Tables -
Analysis 8.8

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 8 Rates of apnoea (episodes/24 h).

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 9 Duration of hospitalisation (days).
Figures and Tables -
Analysis 8.9

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 9 Duration of hospitalisation (days).

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 10 Death before discharge.
Figures and Tables -
Analysis 8.10

Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 10 Death before discharge.

Summary of findings for the main comparison. NIPPV versus NCPAP

NIPPV versus NCPAP

Patient or population: preterm neonates after extubation
Setting: neonatal intensive care unit
Intervention: NIPPV
Comparison: NCPAP

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with NCPAP

Risk with NIPPV

Respiratory failure post extubation

Study population

RR 0.70
(0.60 to 0.80)

1431
(10 studies)

Moderatea

Risk of bias: intervention unblinded

OIS 554

413 per 1000

289 per 1000
(248 to 330)

Endotracheal re‐intubation during the week post extubation

Study population

RR 0.76
(0.65 to 0.88)

1301

(8 studies)

Moderatea

Risk of bias: intervention unblinded

OIS 724

396 per 1000

301 per 1000
(257 to 348)

Abdominal distension requiring cessation of feeds

Study population

RR 1.27
(0.64 to 2.53)

199

(4 studies)

Lowa,b

Risk of bias: intervention unblinded Imprecision: wide confidence intervals

112 per 1000

143 per 1000
(72 to 284)

Gastrointestinal perforation

Study population

RR 0.94
(0.60 to 1.48)

1066

(5 studies)

Moderatea

Risk of bias: intervention unblinded

66 per 1000

62 per 1000
(40 to 98)

Necrotising enterocolitis

Study population

RR 0.87
(0.64 to 1.19)

1214
(6 studies)

Moderatea

Risk of bias: intervention unblinded

127 per 1000

110 per 1000
(81 to 151)

Chronic lung disease (oxygen supplementation at 36 weeks)

Study population

RR 0.94
(0.80 to 1.10)

1140

(6 studies)

Moderatea

Risk of bias: intervention unblinded

355 per 1000

334 per 1000
(284 to 391)

Pulmonary air leak

Study population

RR 0.48
(0.28 to 0.82)

1229
(6 studies)

Moderatea

Risk of bias: intervention unblinded

OIS 749

61 per 1000

29 per 1000
(17 to 50)

Duration of hospitalisation (days)

Mean duration of hospitalisation (days) was 0

Mean duration of hospitalisation (days) in the intervention group was 2.77 higher (0.04 to 5.51 higher)

238
(4 studies)

Lowa,b

Risk of bias: intervention unblinded Imprecision: wide confidence intervals

Death before discharge

Study population

RR 0.69
(0.48 to 0.99)

1237
(6 studies)

Moderatea

Risk of bias: intervention unblinded

Imprecision

OIS 1844

104 per 1000

72 per 1000
(50 to 103)

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; OR: odds ratio; RR: risk ratio.

GRADE Working Group grades of evidence.
High quality: We are very confident that the true effect lies close to the estimate of effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aIntervention unblinded.

bImprecise estimate (wide confidence intervals).

Figures and Tables -
Summary of findings for the main comparison. NIPPV versus NCPAP
Comparison 1. NIPPV versus NCPAP to prevent extubation failure

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Respiratory failure post extubation Show forest plot

10

1431

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.60, 0.80]

1.1 Short (nasal) prongs

7

1275

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.63, 0.84]

1.2 Long (nasopharyngeal) prongs

3

156

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.14, 0.65]

2 Endotracheal re‐intubation Show forest plot

8

1301

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.65, 0.88]

3 Post hoc analysis (high‐quality studies): respiratory failure post extubation Show forest plot

7

1266

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.63, 0.85]

Figures and Tables -
Comparison 1. NIPPV versus NCPAP to prevent extubation failure
Comparison 2. NIPPV versus NCPAP and gastrointestinal complications

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abdominal distension leading to cessation of feeds Show forest plot

4

199

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [0.64, 2.53]

2 Gastrointestinal perforation Show forest plot

5

1066

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.60, 1.48]

3 Necrotising enterocolitis Show forest plot

6

1214

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.64, 1.19]

Figures and Tables -
Comparison 2. NIPPV versus NCPAP and gastrointestinal complications
Comparison 3. NIPPV versus NCPAP to improve pulmonary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Chronic lung disease (oxygen supplementation at 36 weeks) Show forest plot

6

1140

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.80, 1.10]

2 Air leaks Show forest plot

6

1229

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.28, 0.82]

Figures and Tables -
Comparison 3. NIPPV versus NCPAP to improve pulmonary outcomes
Comparison 4. NIPPV versus NCPAP and mortality

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death before discharge Show forest plot

6

1237

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.48, 0.99]

Figures and Tables -
Comparison 4. NIPPV versus NCPAP and mortality
Comparison 5. NIPPV versus NCPAP and duration of hospital admission

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Duration of hospital admission (days) Show forest plot

4

238

Mean Difference (IV, Fixed, 95% CI)

2.77 [0.04, 5.51]

Figures and Tables -
Comparison 5. NIPPV versus NCPAP and duration of hospital admission
Comparison 6. NIPPV versus NCPAP and apnoea

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rates of apnoea (episodes/24 h) Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐7.92, 1.72]

Figures and Tables -
Comparison 6. NIPPV versus NCPAP and apnoea
Comparison 7. NIPPV versus NCPAP (synchronised vs non‐synchronised)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Respiratory failure post extubation Show forest plot

10

1431

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.60, 0.80]

1.1 Synchronised NIPPV

5

272

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.15, 0.41]

1.2 Non‐synchronised NIPPV

4

314

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.46, 0.93]

1.3 Mixed NIPPV devices

1

845

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

2 Endotracheal re‐intubation during the week post extubation Show forest plot

10

1431

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.64, 0.85]

2.1 Synchronised NIPPV

5

272

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.19, 0.57]

2.2 Non‐synchronised NIPPV

4

314

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.46, 0.93]

2.3 Mixed NIPPV devices

1

845

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

3 Abdominal distension requiring cessation of feeds Show forest plot

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.77, 4.05]

3.1 Synchronised NIPPV

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.77, 4.05]

3.2 Non‐synchronised NIPPV

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed NIPPV devices

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Gastrointestinal perforation Show forest plot

5

1052

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

4.1 Synchronised NIPPV

3

159

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Non‐synchronised NIPPV

1

48

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed NIPPV devices

1

845

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

5 Necrotising enterocolitis Show forest plot

6

1214

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.64, 1.19]

5.1 Synchronised NIPPV

5

1147

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.64, 1.20]

5.2 Non‐synchronised NIPPV

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.11, 4.79]

5.3 Mixed NIPPV devices

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Chronic lung disease (oxygen supplementation at 36 weeks) Show forest plot

6

1108

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.79, 1.10]

6.1 Synchronised NIPPV

3

181

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.44, 0.95]

6.2 Non‐synchronised NIPPV

2

185

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.47, 1.16]

6.3 Mixed NIPPV devices

1

742

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.88, 1.30]

7 Pulmonary air leak Show forest plot

6

1222

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.44, 1.02]

7.1 Synchronised NIPPV

2

113

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.14, 0.90]

7.2 Non‐synchronised NIPPV

3

259

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.58, 2.08]

7.3 Mixed NIPPV devices

1

850

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.29, 1.28]

8 Rates of apnoea (episodes/24 h) Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐7.92, 1.72]

8.1 Synchronised NIPPV

1

54

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐7.92, 1.72]

8.2 Non‐synchronised NIPPV

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed NIPPV devices

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Duration of hospitalisation (days) Show forest plot

4

244

Mean Difference (IV, Fixed, 95% CI)

2.72 [‐0.01, 5.44]

9.1 Synchronised NIPPV

3

181

Mean Difference (IV, Fixed, 95% CI)

3.39 [0.52, 6.25]

9.2 Non‐synchronised NIPPV

1

63

Mean Difference (IV, Fixed, 95% CI)

‐3.48 [‐12.20, 5.24]

9.3 Mixed NIPPV devices

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Death before discharge Show forest plot

6

1237

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.48, 0.99]

10.1 Synchronised NIPPV

2

111

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.21, 4.44]

10.2 Non‐synchronised NIPPV

3

266

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.16, 0.75]

10.3 Mixed NIPPV devices

1

860

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.55, 1.31]

Figures and Tables -
Comparison 7. NIPPV versus NCPAP (synchronised vs non‐synchronised)
Comparison 8. NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Respiratory failure post extubation Show forest plot

10

1431

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.60, 0.80]

1.1 Ventilator‐generated NIPPV

8

450

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.22, 0.47]

1.2 Bilevel NIPPV

1

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.50, 1.21]

1.3 Mixed NIPPV devices

1

845

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

2 Endotracheal re‐intubation during the week post extubation Show forest plot

10

1431

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.64, 0.85]

2.1 Ventilator‐generated NIPPV

8

450

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.26, 0.59]

2.2 Bilevel NIPPV

1

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.50, 1.21]

2.3 Mixed NIPPV devices

1

845

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.72, 1.01]

3 Abdominal distension requiring cessation of feeds Show forest plot

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.77, 4.05]

3.1 Ventilator‐generated NIPPV

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.77, 4.05]

3.2 Bilevel NIPPV

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed NIPPV devices

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Gastrointestinal perforation Show forest plot

6

1133

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.60, 1.48]

4.1 Ventilator‐generated NIPPV

6

1133

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.60, 1.48]

4.2 Bilevel NIPPV

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed NIPPV devices

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Necrotising enterocolitis Show forest plot

6

1214

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.64, 1.19]

5.1 Ventilator‐generated NIPPV

4

219

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.21, 1.93]

5.2 Bilevel NIPPV

1

136

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.38, 2.78]

5.3 Mixed NIPPV devices

1

859

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.63, 1.24]

6 Chronic lung disease (oxygen supplementation at 36 weeks) Show forest plot

7

1168

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.81, 1.11]

6.1 Ventilator‐generated NIPPV

5

298

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.50, 0.95]

6.2 Bilevel NIPPV

1

128

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.59, 1.55]

6.3 Mixed NIPPV devices

1

742

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.88, 1.30]

7 Pulmonary air leak Show forest plot

6

1229

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.28, 0.82]

7.1 Ventilator‐generated NIPPV

4

243

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.16, 0.79]

7.2 Bilevel NIPPV

1

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed NIPPV devices

1

850

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.29, 1.28]

8 Rates of apnoea (episodes/24 h) Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐7.92, 1.72]

8.1 Ventilator‐generated NIPPV

1

54

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐7.92, 1.72]

8.2 Bilevel NIPPV

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed NIPPV devices

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Duration of hospitalisation (days) Show forest plot

4

244

Mean Difference (IV, Fixed, 95% CI)

2.72 [‐0.01, 5.44]

9.1 Ventilator‐generated NIPPV

4

244

Mean Difference (IV, Fixed, 95% CI)

2.72 [‐0.01, 5.44]

9.2 Bilevel NIPPV

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Mixed NIPPV devices

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Death before discharge Show forest plot

6

1237

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.48, 0.99]

10.1 Ventilator‐generated NIPPV

4

241

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.18, 0.81]

10.2 Bilevel NIPPV

1

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.15, 2.48]

10.3 Mixed NIPPV devices

1

860

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.55, 1.31]

Figures and Tables -
Comparison 8. NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV)