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مقایسه تهویه با فشار مثبت متناوب از راه بینی (NIPPV) در برابر تهویه با فشار مثبت مداوم راه هوایی از راه بینی (NCPAP) برای نوزادان نارس پس از اکستوباسیون

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Referencias

Barrington 2001 {published and unpublished data}

Barrington KJ, Finer NN, Bull D. Randomised controlled trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics 2001;107(4):638‐41. CENTRAL

Friedlich 1999 {published data only}

Friedlich P, Lecart C, Posen R, Ramicone E, Chan L, Ramanathan R. A randomized trial of nasopharyngeal‐synchronised intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants following extubation. Journal of Perinatology 1999;19(6 Pt 1):413‐8. CENTRAL

Gao 2010 {published data only}

Gao WW, Tan SZ, Chen YB, Zhang Y, Wang Y. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome. Chinese Journal of Contemporary Pediatrics 2010;12(7):524‐6. CENTRAL

Jasani 2016 {published data only}

Jasani B, Nanavati R, Kabra N, Rajdeo S, Bhandari V. Comparison of non‐synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post‐extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. Journal of Maternal‐Fetal & Neonatal Medicine 2016;29(10):1546‐51. [PUBMED: 26135774]CENTRAL

Kahramaner 2014 {published data only}

Kahramaner Z, Erdemir A, Turkoglu E, Cosar H, Sutcuoglu S, Ozer EA. Unsynchronized nasal intermittent positive pressure versus nasal continuous positive airway pressure in preterm infants after extubation. Journal of Maternal‐Fetal & Neonatal Medicine 2014;27(9):926‐9. [DOI: 10.3109/14767058.2013.846316]CENTRAL

Khalaf 2001 {published data only}

Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomised controlled trial comparing synchronized nasal intermittent positive pressure ventilation (SNIPPV) versus nasal continuous positive airway pressure (NCPAP) as mode of extubation. Pediatric Research 1999;45:204a. CENTRAL
Khalaf MN, Brodsky N, Hurley J, Bhandari V. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics 2001;108(1):13‐7. [MEDLINE: 11433048]CENTRAL

Khorana 2008 {published data only}

Khorana M, Paradeevisut H, Sangtawesin V, Kanjanapatanakul W, Chotigeat U, Ayutthaya JKN. A randomized trial of non‐synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV) vs. nasal continuous positive airway pressure (nCPAP) in the prevention of extubation failure in preterm under 1500 grams. Journal of the Medical Association of Thailand 2008;91(3):S136‐42. CENTRAL

Kirpalani 2013 {published and unpublished data}

Kirpalani H, Millar D, Lemyre B, Yoder BA, Chiu A, Roberts RS, NIPPV Study Group. A trial comparing noninvasive ventilation strategies in preterm infants. New England Journal of Medicine 2013;369(7):611‐20. [DOI: 10.1056/NEJMoa1214533]CENTRAL

Moretti 2008 {published data only}

Moretti C, Giannini L, Fassi C, Gizzi C, Papoff P, Colarizi P. Nasal flow‐synchronized intermittent positive pressure ventilation to facilitate weaning in very low‐birthweight infants: unmasked randomized controlled trial. Pediatrics International 2008;50:85‐91. CENTRAL

O'Brien 2012 {published data only}

O'Brien K, Campbell C, Havlin L, Wenger L, Shah V. Infant flow biphasic nasal continuous positive airway pressure (BP‐nCPAP) vs. infant flow nCPAP for the facilitation of extubation in infants less than or = 1250 grams: a randomized controlled trial. BMC Pediatrics 2012;12:43. CENTRAL

Ali 2007 {published data only}

Ali N, Claure N, Alegria X, D'Ugard C, Organero R, Bancalari E. Effects of non‐invasive pressure support ventilation (NI‐PSV) on ventilation and respiratory effort in very low birth weight infants. Pediatric Pulmonology 2007;42:704‐10. CENTRAL

Bhandari 2007 {published data only}

Bhandari V, Gavino RG, Nedrelow JH, Pallela P, Salvadore A, Ehrenkranz RA, et al. A randomized controlled trial of synchronized nasal intermittent positive pressure ventilation in RDS. Journal of Perinatology 2007;11:697‐703. CENTRAL

Bisceglia 2007 {published data only}

Bisceglia M, Belcastro A, Poerio V, Raimondi F, Mesuraca L, Crugliano C, et al. A comparison of nasal intermittent versus continuous positive pressure delivery for the treatment of moderate respiratory syndrome in preterm infants. Minerva Pediatrica 2007;59:91‐5. CENTRAL

DeSimone 2010 {published data only}

DeSimone OA, Sommers R, Destin K, Mance M, Matook S, Stonestreet B, et al. Nasal intermittent positive pressure ventilation (NIPPV) does not facilitate earlier extubation in infants less than 28 weeks gestation: a pilot study. Pediatric Academic Society. 2010. CENTRAL

Kishore 2009 {published data only}

Kishore MSS, Dutta S, Kumar P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Acta Paediatrica 2009;98:1412‐5. CENTRAL

Kugelman 2007 {published data only}

Kugelman A, Feferkorn I, Riskin A, Chistyakov I, Kaufman B, Bader D. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized controlled prospective study. Journal of Pediatrics 2007;150:521‐6. CENTRAL

Kumar 2011 {published data only}

Kumar M, Avasthi S, Ahuja S, Malik GK, Singh SN. Unsynchronized nasal intermittent positive pressure ventilation to prevent extubation failure in neonates: a randomized controlled trial. Indian Journal of Pediatrics 2011;78(7):801‐6. [DOI: 10.1007/s12098‐010‐0357‐x; PUBMED: 21287368]CENTRAL

Lin 1998 {published and unpublished data}

Lin CH, Wang ST, Lin YJ, Yeh TF. Efficacy of nasal intermittent positive pressure ventilation in treating apnea of prematurity. Pediatric Pulmonology 1998;26(5):349‐53. CENTRAL

Meneses 2011 {published data only}

Meneses J, Bhandari V, Guilherme AJ, Herrmann D. Noninvasive ventilation for respiratory distress syndrome: a randomized controlled trial. Pediatrics 2011;127(2):300‐7. CENTRAL

Moretti 1999 {published data only}

Moretti C, Gizzi C, Papoff P, Lampariello S, Capoferri M, Calcagnini G, et al. Comparing the effects of nasal synchronized intermittent positive pressure ventilation (nSIPPV) and nasal continuous positive airway pressure (nCPAP) after extubation in very low birth weight infants. Early Human Development 1999;56:166‐77. CENTRAL

Pantalitschka 2009 {published data only}

Pantalitschka T, Sievers J, Urschitz MS, Herberts T, Reher C, Poets CF. Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 2009;94(4):F245‐8. CENTRAL

Ramanathan 2012 {published data only}

Ramanathan R, Sekar KC, Rasmussen M, Bhatia J, Soll RF. Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants under 30 weeks gestation: a randomized, controlled trial. Journal of Perinatology 2012;32(5):336‐43. CENTRAL

Ryan 1989 {published data only}

Ryan CA, Finer NN, Peters KL. Nasal intermittent positive‐pressure ventilation offers no advantages over nasal continuous positive airway pressure in apnea of prematurity. American Journal of Diseases in Childhood 1989;143(10):1196‐8. CENTRAL

Shi 2010 {published data only}

Shi Y, Tang S, Zhao J, Hu Z, Li T. Efficiency of nasal intermittent positive pressure ventilation vs nasal continuous positive airway pressure on neonatal respiratory distress syndrome: a prospective, randomized, controlled study. Acta Academiae Medicinae Militaris Tertiae 2010;32(18):1991‐4. CENTRAL

Silveira 2015 {published data only}

Silveira CS, Leonardi KM, Melo AP, Zaia JE, Brunherotti MA. Response of preterm infants to 2 noninvasive ventilatory support systems: nasal CPAP and nasal intermittent positive‐pressure ventilation. Respiratory Care 2015;60(12):1772‐6. [26374907]CENTRAL

El‐Farash 2013 {unpublished data only}

Nasal Continuous Airway Pressure (n‐CPAP) vs Nasal Bilevel Positive Airway Pressure (n‐BiPAP) for RDS. Ongoing studyJanuary 2013.

Estay 2013 {unpublished data only}

Non‐Invasive Ventilation vs Continuous Positive Airway Pressure After Extubation in Very Low Birth Weight Infants. Ongoing studyDecember 2011.

NCT02396693 {published data only}

NCT02396693. Successful Extubation and Noninvasive Ventilation in Preterm ≤ 1500g Terms. clinicaltrials.gov/show/NCT02396693 (accessed 7 December 2015). CENTRAL

Shi 2013 {unpublished data only}

Nasal Intermittent Positive Pressure Ventilation in Newborn Infants With Respiratory Distress Syndrome. Ongoing studyJanuary 2008.

Victor 2011 {published data only}

Victor S,  Extubate Trial Group. EXTUBATE: a randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial. Trials2011; Vol. 12:257. CENTRAL

Bancalari 2013

Bancalari E, Claure N. The evidence for non‐invasive ventilation in the preterm infant. Archives of Disease in Childhood. Fetal and Neonatal Edition 2013;98(2):F98‐102.

Bott 1993

Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 1993;341:1555‐7.

Davis 2003b

Davis PG, Henderson‐Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD000143]

Davis 2009

Davis PG, Morley CJ, Owen LS. Non‐invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Seminars in Fetal and Neonatal Medicine 2009;14:14‐20.

Ellis 1988

Ellis ER, Grunstein RR, Chan S, Bye PT, Sullivan CE. Noninvasive ventilatory support during sleep improves respiratory failure in kyphoscoliosis. Chest 1988;94:811‐5.

Garland 1985

Garland JS, Nelson DB, Rice T, Neu J. Increased risk of gastrointestinal perforations in neonates mechanically ventilated with either face mask or nasal prongs. Pediatrics 1985;76:406‐10.

GRADEpro 2008 [Computer program]

Brozek J, Oxman A, Schünemann H. GRADEpro. Version 3.2 for Windows. The GRADE Working Group, 2008.

Guyatt 2011a

Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction ‐ GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. [PUBMED: 21195583]

Guyatt 2011b

Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso‐Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence ‐ study limitations (risk of bias). Journal of Clinical Epidemiology 2011;64(4):407‐15. [PUBMED: 21247734]

Guyatt 2011c

Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso‐Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence ‐ imprecision. Journal of Clinical Epidemiology 2011;64(12):1283‐93. [PUBMED: 21839614]

Guyatt 2011d

Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence ‐ inconsistency. Journal of Clinical Epidemiology 2011;64(12):1294‐302. [PUBMED: 21803546]

Guyatt 2011e

Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence ‐ indirectness. Journal of Clinical Epidemiology 2011;64(12):1303‐10. [PUBMED: 21802903]

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

Kiciman 1998

Kiciman NM, Andréasson B, Bernstein G, Mannino FL, Rich W, Henderson C, et al. Thoracoabdominal motion in newborns during ventilation delivered by endotracheal tube or nasal prongs. Pediatric Pulmonology 1998;25:175‐81.

Lee 2015

Lee J, Kim HS, Jung YH, Shin SH, Choi CW, Kim EK, et al. Non‐invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 2015;100(6):F507‐13.

Owen 2007

Owen LS, Morley CJ, Davis PG. Nasal intermittent positive pressure ventilation: what do we know in 2007?. Archives of Disease in Childhood. Fetal and Neonatal Edition 2007;92(5):F414‐8.

Owen 2008

Owen LS, Morley CJ, Davis PG. Neonatal nasal intermittent positive pressure ventilation: a survey of practice in England. Archives of Disease in Childhood. Fetal and Neonatal Edition 2008;93(2):F148‐50.

Owen 2016

Owen LS, Manley BJ. Nasal intermittent positive pressure ventilation in preterm infants: equipment, evidence and synchronization. Seminars in Fetal and Neonatal Medicine 2016;21(3):146‐153.

Piper 1992

Piper AJ, Parker S, Torzillo PJ, Sullivan CE, Bye PT. Nocturnal nasal IPPV stabilizes patients with cystic fibrosis and hypercapnic respiratory failure. Chest 1992;102:846‐50.

Schünemann 2013

Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GWG. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. www.guidelinedevelopment.org/handbook.Updated October 2013.

Stein 2012

Stein D, Howard D. Neurally adjusted ventilatory assist in neonates weighing <1500 grams: a retrospective analysis. Journal of Pediatrics 2012;160(5):786‐9.

Davis 2001

Davis PG, Lemyre B, De Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD003212]

Davis 2003a

Davis PG, Lemyre B, De Paoli AG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD003212]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Barrington 2001

Methods

Randomised controlled trial comparing effects of synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants with birth weight < 1250 grams (mean 831 ± 193 grams), < 6 weeks of age (mean 7.6 ± 9.7 days), requiring < 35% O2 and < 18 breaths/min on SIMV. All infants were loaded with aminophylline before extubation.

Interventions

Experimental group: synchronised NIPPV = nSIMV; ventilator rate 12 breaths/min and PIP 16 cmH2O, PEEP 6 cmH2O, PIP increased to achieve measured pressure ≥ 12 cmH2O. Graseby capsule, Infant Star ventilator and Hudson nasal prongs were used.
Control group: NCPAP 6 cmH2O

Outcomes

Primary: failure of extubation by 72 hours because pCO2 > 70 mmHg, oxygen requirement > 70% or apnoea was severe or recurrent (defined)
Secondary: rates of re‐intubation, abdominal distension, feeding intolerance and CLD

Notes

Power calculation performed
54 infants enrolled ‐ 27 in each group
Most infants not responding to NCPAP were tried on NIPPV before re‐intubation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Table of random numbers

Allocation concealment (selection bias)

Low risk

Adequate: sequentially numbered sealed opaque envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All participants accounted for

Selective reporting (reporting bias)

Unclear risk

Secondary outcomes not listed
Friedlich 1999

Methods

Randomised controlled trial comparing effects of synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants with birth weight 500 to 1500 grams (mean 963 ± 57 grams in experimental group and 944 ± 43 grams in control group) considered ready for extubation (SIMV rate < 12 breaths/min, peak pressure < 23 cmH2O, end expiratory pressure < 6 cmH2O, oxygen requirement < 40%. Aminophylline not mandated but given to about 85% of infants. Extubated at 26.3 ± 6.1 days of life in experimental group and at 19.9 ± 3.8 days of life in control group
Excluded were infants with sepsis, NEC, symptomatic PDA, congenital anomalies.

Interventions

Experimental group: nasopharyngeal 3‐Fr gauge tube, Infant Star ventilator, synchronised NIPPV = nSIMV with rate of 10 breaths/min, PIP = that before extubation, PEEP 4‐6 cmH2O, IT 0.6 seconds
Control group: nasopharyngeal CPAP to desired level of attending

Outcomes

Primary: failure of extubation by 48 hours because pH < 7.25, pCO2 increased by 25%, oxygen requirement > 60%, SIMV rate > 20 (in NIPPV group), PIP > 26 cmH2O or PEEP > 8 cmH2O in NIPPV group, or apnoea requiring bag and mask ventilation
Secondary: endotracheal re‐intubation, abdominal distension, perforation or NEC, feeding delay (not defined) and nasal bleeding

Notes

Power calculation performed. Study was closed early after interim analysis (stopping rule not specified).
41 infants were enrolled: 22 in NIPPV group and 19 in NCPAP group.
Most infants not responding to NCPAP were tried on NIPPV before re‐intubation.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Unspecified

Allocation concealment (selection bias)

Low risk

Adequate: sealed randomisation cards

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All accounted for

Selective reporting (reporting bias)

Unclear risk

No outcomes listed, only objectives for the study
Gao 2010

Methods

Randomised controlled trial comparing effects of synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants at gestational age < 36 weeks (mean 32.3 ± 1.6 weeks in experimental group and 32.6 ± 1.4 weeks in control group) with birth weight < 2000 grams (mean 1264 ± 153 grams in experimental group and 1246 ± 161 grams in control group) with RDS after surfactant

Excluded were infants with severe abnormalities, not specified.

Interventions

Experimental group: synchronised NIPPV via different devices (NEWPORT 150 and 200; Teama; Stephan; Millennium). Rate 40 breaths/min, PIP 20 cmH2O, PEEP 5 cmH2O

Control group: NCPAP via Infant Flow Driver (EME); CPAP 4 to 8 cmH2O

Outcomes

Failed extubation, defined as pCO2 > 70 mmHg or FiO2 > 0.6 to maintain SaO2 > 88% or mean pressure > 8 cmH2O (in NIPPV group) or severe apnoea (in NCPAP group), defined as > 6 episodes in 24 hours or > 2 episodes requiring PPV. Air leak, hypercapnia, hypoxia

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified

Allocation concealment (selection bias)

Unclear risk

No study flow diagram; unclear if exclusions; English translation imprecise and unclear

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

No flow diagram

Selective reporting (reporting bias)

Unclear risk

No outcomes listed
Jasani 2016

Methods

Randomised controlled trial comparing effects of non‐synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Preterm infants ≤ 1500 grams at birth (mean 1187 grams at 30.8 weeks in the intervention group; mean 1153 grams at 30.6 weeks in the control group)

Excluded were infants with suspected upper airway obstruction, airway anomaly, major cardiopulmonary malformation.

Interventions

Experimental group: NIPPV provided by Bear Cub ventilator, non‐synchronised. Rate same as pre‐extubation, PIP 4 over pre‐extubation settings, PEEP ≤ 5

Control group: CPAP 5 to 6 cmH2O via Bear Cub or Viasys Infant Flow CPAP

Outcomes

Failed extubation within 72 hours, defined as meeting 1 or more of the following: pH < 7.26 and pCO2 > 59 mmHg; recurrent apnoea (> 2 episodes per hour); 1 apnoea needing PPV or paO2 < 51 mmHg with FiO2 > .59

Secondary outcomes: duration of non‐invasive ventilation, total duration of ventilation, days on oxygen, air leaks, BPD, PDA, IVH grade 3‐4, NEC, ROP ≥ grade 3, length of stay, mortality, GI perforation

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation software

Allocation concealment (selection bias)

Low risk

Opaque sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Intervention could not be blinded.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Despite criteria to define extubation failure, intervention was not blinded.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All participants accounted for

Selective reporting (reporting bias)

Low risk
Kahramaner 2014

Methods

Randomised controlled trial comparing effects of non‐synchronised nasal intermittent positive pressure ventilation vs continuous positive airway pressure in preterm infants after extubation

Participants

A total of 67 premature infants at < 35 weeks' gestation with birth weight < 2000 grams receiving mechanical ventilation because of respiratory distress syndrome (RDS)

Interventions

Intervention group: non‐synchronised nasal NIPPV with shortened endotracheal tube via Babylog 8000. Rate 25, PIP 2 cmH2O above pre‐extubation setting, PEEP 6 cmH2O. Control group: NCPAP 6 cmH2O with binasal prongs via Sindi driver

Outcomes

Extubation failure at 48 hours, defined as pH < 7.25 and pCO2 > 60 or severe or frequent apnoea, or FiO2 > 60% to keep SaO2 88% to 93% or frequent desaturations not responding to increasing settings

Secondary outcomes: air leak, death, NEC, IVH, severe IVH, ROP, sepsis, nasal injury, BPD

Notes

Outcomes not specified in the Methods section. No sample size calculation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified in the text

Allocation concealment (selection bias)

Low risk

Sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

High risk

No flow diagram. No sample size calculation

Selective reporting (reporting bias)

Unclear risk

No outcomes specified in the Methods section
Khalaf 2001

Methods

Randomised controlled trial comparing effects of synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants at gestational age < 34 weeks with RDS ventilated by endotracheal tube. Mean birth weight 1088 grams in experimental group and 1032 grams in control group with mean gestational age 28 weeks. Ventilator settings PIP ≤ 16 cmH2O, PEEP ≤ 5 cmH2O, ventilator rate 15 to 25 breaths/min and O2 < 35%. All had a therapeutic blood level of aminophylline and hematocrit > 40%.

Interventions

Experimental group: synchronised NIPPV via Argyle prongs, Infant Star ventilator at PEEP ≤ 5 cmH2O, with ventilator rate 15 to 25 breaths/min and PIP set at 2 to 4 cmH2O above that used pre‐extubation. Gas flow set at 8 to 10 L/min in both groups
Control group: NCPAP delivered by Argyle prongs from a Bear Cub or Infant Star ventilator at 4 to 6 cmH2O

Outcomes

Primary: failure of extubation by 72 hours because pH < 7.25 or pCO2 > 60 mmHg, single episode of severe apnoea requiring bag and mask ventilation or frequent apnoea or desaturations (defined)
Secondary: included CLD defined as supplemental O2 requirement at 36 weeks' corrected age, days of ventilation and hospitalisation. Data on rates of feeding intolerance provided by study authors

Notes

Power calculation was performed. 64 infants were enrolled: 34 in NIPPV group and 30 in NCPAP group.
2 infants not responding to NCPAP were tried on NIPPV (successfully) before re‐intubation.
For the outcome "abdominal distension causing cessation of feeds", denominators were number of infants offered enteral feeds during the 72‐hour study period, i.e. 21 in NIPPV group and 20 in NCPAP group.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified

Allocation concealment (selection bias)

Low risk

Adequate: sealed randomisation cards

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All participants accounted for

Selective reporting (reporting bias)

Unclear risk

No outcomes stated besides objectives
Khorana 2008

Methods

Randomised controlled trial comparing effects of non‐synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants ≤ 34 weeks (mean 28 ± 2.6 weeks and 29 ± 2.1 weeks) or birth weight ≤ 1500 grams (mean 984 ± 218 grams and 1185 ± 219 grams) considered ready for extubation (SIMV rate ≤ 15 breaths/min, peak pressure ≤ 15 cmH2O, end expiratory pressure < 6 cmH2O, O2 requirement < 41%. Aminophylline pre‐extubation. Extubated at 12.9 ± 9.9 days of life in experimental group and at 6.9 ± 6.0 days of life in control group
Excluded were infants with major congenital malformations, cleft lip or palate, symptomatic PDA, NEC, sepsis, IVH grade 3‐4.

Interventions

Experimental group: non‐synchronised NIPPV via bi‐nasopharyngeal prongs on Bear 750 ventilator; same settings as pre‐extubation on the ventilator

Control group: NCPAP delivered by bi‐nasopharyngeal prongs from a Bear 750 ventilator; CPAP level same as pre‐extubation level

Aminophylline load before extubation

Outcomes

Primary: re‐intubation or failure of extubation within 1 week because of:

  • pH ≤ 7.25 or pCO2 ≥ 60 mmHg or pCO2 ≥ 25% higher than pre‐extubation or FiO2 ≥ 0.6 for SaO2 92 to 95%; or

  • increased settings: intermittent mandatory ventilation rate ≥ 20, PIP ≥ 20 cmH2O, mean airway pressure ≥ 8 cmH2O; or

  • single episode of severe apnoea requiring bag and mask ventilation; or

  • need for re‐intubation as deemed necessary

Secondary: respiratory failure, death, abdominal distension, NEC, gastrointestinal perforation, apnoea, atelectasis and sepsis

Notes

Imbalance between groups at randomisation (NIPPV group: lower birth weight, fewer boys, higher antenatal steroids)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified

Allocation concealment (selection bias)

Unclear risk

Method of allocation concealment not specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All participants accounted for

Selective reporting (reporting bias)

Low risk

All specified secondary outcomes were reported.
Kirpalani 2013

Methods

Randomised multi‐centre controlled trial comparing effects of NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants with birth weight < 1000 grams at < 30 weeks

2 subgroups: intubated for > 24 hours and < 28 days at extubation; intubated < 24 hours or never intubated. Infants never intubated were not included in this review.

Criteria for extubation and for re‐intubation were provided.

Interventions

NIPPV (any device) vs NCPAP; guidelines provided for both

Outcomes

Death or moderate to severe BPD according to physiological definition

Notes

2 subgroups of infants; only subgroup intubated for at least 24 hours and extubated before 28 days included in this review

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Web‐based randomisation

Allocation concealment (selection bias)

Low risk

Randomisation immediately pre‐extubation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Flow diagram in full study

Selective reporting (reporting bias)

Low risk
Moretti 2008

Methods

Randomised controlled trial comparing effects of synchronised NIPPV vs NCPAP in preterm infants after extubation

Participants

Infants with birth weight < 1251 grams (mean 908 ± 192 grams in experimental group and 957 ± 213 grams in control group) with RDS requiring ventilation within first 48 hours of life and who met criteria for extubation by day 14 of life. Criteria for extubation: stable or improving clinical condition; receiving assist/control or proportional assist ventilation; low ventilatory setting (FiO2 ≤ 0.35, PIP ≤ 15 cmH2O and ventilator rate ≤ 15 breaths/min or elastance < 1 to maintain pCO2 ≤ 60 mmHg); no clinical or haematological sign of infection; haemoglobin ≥ 10.0 grams/dL Extubated at a median of 4 days (range 1 to 14) and 6 days (range 1 to 14)
Excluded were infants with IVH grade 3 to 4, gastrointestinal surgery, congenital malformation and cardiovascular and neuromuscular abnormalities.

Interventions

Experimental group: synchronised NIPPV via short nasal prongs on Giulia ventilator; same settings as pre‐extubation on the ventilator. PEEP 3 to 5 cmH2O, PIP titrated according to infant from 10 to 20 cmH2O, flow rate 6 to 10 L/min
Control group: NCPAP delivered by short nasal prongs from a Giulia ventilator; CPAP level 3 to 5 cmH2O; flow rate 6 to 10 L/min

Caffeine load before extubation

Outcomes

Primary: need for re‐intubation within 72 hours because of:

  • persistent severe acidosis (arterial pH < 7.2 with pCO2 > 70 mmHg); or

  • severe recurrent apnoeic episodes not responding to increased ventilatory settings and then requiring bag ventilation; or

  • hypoxaemia (SaO2 < 90% or pO2 < 60 mmHg with FiO2 consistently ≥ 0.70)

Secondary: number of days on endotracheal mechanical ventilation, number of days on O2, CLD (O2 at 36 weeks with abnormal chest x‐ray), duration of hospital stay, air leaks, ROP, sepsis, feeding intolerance (presence of 4‐hour gastric aspirate > 25% of feed volume or containing bile)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified

Allocation concealment (selection bias)

Low risk

Sealed opaque envelopes to conceal allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No flow diagram

Selective reporting (reporting bias)

Low risk

All outcomes accounted for
O'Brien 2012

Methods

Randomised controlled trial comparing effects of non‐synchronised NIPPV delivered by a bilevel device vs NCPAP in preterm infants after extubation

Participants

Infants with birth weight < 1251 grams (mean 901 ̃± 200 grams in experimental group and 896 ± 156 grams in control group) who were intubated at birth for RDS (some were prophylactically intubated to received surfactant) and who met criteria for extubation (no time limit)

Criteria for extubation: ventilator rate < 20 breaths/min, PIP ≥ 16 cmH2O and FiO2 ≥ .35. If on high‐frequency oscillatory ventilation: frequency of 9 to 13 Hz, amplitude < 20%, MAP ≤ 8 and FiO2 ≤ 35%. Extubated at a median of 3 days (range 1 to 67) in experimental group and 3 days (range 1 to 62) in control group. All received caffeine during first week of life. Unclear if load pre‐extubation
Excluded were infants with congenital anomalies of the upper airway, acquired nasal septum injury and major congenital or chromosomal abnormalities.

Interventions

Experimental group: NIPPV with SiPAP bilevel device, non‐synchronised. Ventilator rate 20 breaths/min, IT 1.0 second. Predefined upper and lower CPAP based on FiO2: 8 over 5 for FiO2 < 30%; 9 over 6 for FiO2 30% to 50%; and 10 over 7 for FiO2 > 50%

Control group: CPAP with SiPAP. Level of CPAP predefined on the basis of FiO2: 5 cmH2O if FiO2 < .30; 6 mH2O if FiO2 .30 to .50; and 7 mH2O if FiO2 > .50

Outcomes

Primary: sustained extubation for 7 days. Re‐intubation criteria: severe apnoea (needing PPV), ≥ 4 apnoeic episodes per hour needing moderate stimulation, O2 > 60%, uncompensated respiratory acidosis (pH < 7.25). Re‐intubation also allowed at clinician discretion for other reasons (concerns regarding sepsis)

Secondary: adverse events (nasal septal injury or erythema, eyelid oedema, abdominal distension, feeding intolerance, pneumothorax). Feeding intolerance = aspirates ≥ 30% of a feed. Abdominal distension ≥ 10% increase in girth. Also: BPD, PDA treated, NEC, IVH 3 to 4, periventricular leukomalacia, ROP

Notes

Study authors overestimated successful extubations in their control group. Recruitment was stopped at half the sample size, as clinical practice had changed and babies were no longer being intubated prophylactically.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random list

Allocation concealment (selection bias)

Low risk

Sealed opaque envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Unblinded intervention

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Flow diagram attached

Selective reporting (reporting bias)

Low risk

All outcomes accounted for and reported

BPD: bronchopulmonary dysplasia; CLD: chronic lung disease; CPAP: continuous positive airway pressure; FiO2: fraction of inspired oxygen; IT: inspiratory time; IVH: intraventricular haemorrhage; NCPAP: nasal continuous positive airway pressure; NEC: necrotising enterocolitis; NIPPV: nasal intermittent positive pressure ventilation; nSIMV: nasal synchronised intermittent mechanical ventilation; pO2: partial pressure of oxygen; pCO2: partial pressure of carbon dioxide; PDA: patent ductus arteriosus; PEEP: positive end expiratory pressure; PIP: peak inspiratory pressure; PPV: positive pressure ventilation; RDS: respiratory distress syndrome; ROP: retinopathy of prematurity; SaO2: oxygen saturation measured by blood analysis; SIMV: synchronised intermittent mechanical ventilation; SiPAP: synchronised inspiratory positive airway pressure.

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Ali 2007

Study compared a form of NIPPV (non‐invasive pressure support ventilation) vs NCPAP in a randomised cross‐over study. Investigators compared short‐term physiological outcomes (tidal volume, breathing effort, etc.). We excluded this study because investigators reported none of the clinical outcomes listed in the inclusion criteria for this review.

Bhandari 2007

Randomised trial of NIPPV vs conventional ventilation for management of RDS (i.e. different groups compared for a different indication). Timing of extubation was different between groups.

Bisceglia 2007

Randomised trial of NIPPV vs NCPAP for moderate RDS (i.e. different inclusion criteria)

DeSimone 2010

Extubation criteria were different for NIPPV and NCPAP groups, whereas infants randomised to NIPPV were extubated from higher ventilator settings.

Kishore 2009

Infants were enrolled early during acute respiratory illness. Intervention was aimed at treating RDS, not upon extubation.

Kugelman 2007

Infants were enrolled early during acute respiratory illness. Intervention was aimed at treating RDS, not upon extubation.

Kumar 2011

RCT evaluating the role of unsynchronised NIPPV vs head box oxygen for prevention of extubation failure in mechanically ventilated preterm neonates weighing less than 2000 grams

Lin 1998

Infants enrolled had apnoea of prematurity; NIPPV or NCPAP was used for treatment.

Meneses 2011

Infants were enrolled early during acute respiratory illness. Intervention was aimed at treating RDS, not upon extubation.

Moretti 1999

Randomised cross‐over trial
Each of 11 infants (mean body weight 1141 grams) received NIPPV and NCPAP in random order for a period of 1 hour.
Outcomes included respiratory rates and pulmonary function tests (i.e. not outcome criteria specified in the protocol).

Pantalitschka 2009

Infants enrolled had apnoea of prematurity; NIPPV or NCPAP was used for treatment.

Ramanathan 2012

Infants were randomised after INSURE procedure and extubation was planned within 2 hours of life. We included this study in the review: early NIPPV vs NCPAP for RDS

Ryan 1989

Infants enrolled had apnoea of prematurity; NIPPV or NCPAP was used for treatment.

Shi 2010

RCT comparing NIPPV vs NCPAP. Not all enrolled infants were premature; mean birth weight of enrolled infants was 2380 grams (experimental group) vs 2416 grams (control group). Unclear if intervention was provided to treat RDS, or if RDS occurred after extubation

INSURE: intubation, surfactant, extubation; NCPAP: nasal continuous positive airway pressure; NIPPV: nasal intermittent positive pressure ventilation; RCT: randomised controlled trial; RDS: respiratory distress syndrome.

Characteristics of studies awaiting assessment [ordered by study ID]

Ir a:

Silveira 2015

Methods

Randomised, prospective, clinical trial

Participants

80 newborns (gestational age < 37 weeks, birth weight < 2500 grams). Infants could be randomised early (for initial management of respiratory distress syndrome (RDS)) or later, after extubation (mean of day 3).

Interventions

40 infants were treated with nasal continuous positive airway pressure (CPAP) and 40 with nasal intermittent positive‐pressure ventilation (NIPPV)

Outcomes

Occurrence of apnoea, progression of respiratory distress, nose bleeding and agitation were defined as ventilation failure. The need for intubation and re‐intubation after failure was observed.

Notes

A portion of the study population may be eligible for inclusion in this review. Communication with a study investigator is ongoing.

Characteristics of ongoing studies [ordered by study ID]

Ir a:

El‐Farash 2013

Trial name or title

Nasal Continuous Airway Pressure (n‐CPAP) vs Nasal Bilevel Positive Airway Pressure (n‐BiPAP) for RDS

Methods

Randomised controlled trial

Participants

Inclusion criteria:

  • preterm infants < 34 weeks

Exclusion criteria:

  • preterm infants with birth weight < 1000 grams

  • infants with Apgar score of 0 at 1 minute

  • presence of any other cause of respiratory distress such as congenital malformation affecting the cardiorespiratory system, neuromuscular disease, foetal hydrops, interventricular haemorrhage and chromosomal aberrations

Interventions

Bilevel positive airway pressure and NCPAP

Outcomes

Primary: failure of extubation during the first 48 hours post extubation, defined as uncompensated respiratory acidosis defined as pH < 7.2 and PaCO2 > 60 mmHg (or) major apnoea requiring mask ventilation
Secondary: maintenance of successful extubation for 7 days from the hour of extubation

Starting date

January 2013

Contact information

Rania A. El‐Farrash, MD

Notes
Estay 2013

Trial name or title

Non‐Invasive Ventilation vs Continuous Positive Airway Pressure After Extubation in Very Low Birth Weight Infants

Methods

Randomised controlled trial

Participants

Infants < 1500 grams and < 34 weeks with RDS and ready for extubation (> 2 hours but < 14 days)

Exclusion criteria: major congenital anomalies, presence of cardiovascular instability, intubation < 2 hours, mechanical ventilation > 14 days, using muscle relaxant, airway anomalies, consent not provided or refused

Interventions

Non‐synchronised NIPPV and NCPAP

Outcomes

Primary: assessment of the need for re‐intubation within the first 72 hours after extubation in the 2 groups

Criteria for failure were met by at least 1 of the following: pH < 7.25 and pCO2 > 65 mmHg; more than 2 episodes of recurrent apnoea per hour associated with bradycardia during 4‐hour continuous; 2 episodes of apnoea that required bag and mask ventilation any time during the study; PaO2 < 50 mmHg with FiO2 > 0.6

Secondary: concerning respiratory support: total duration on endotracheal tube ventilation; total duration on NCPAP; total duration on supplemental O2, incidence of pneumothorax, BPD and death. Other outcomes included incidence of patent ductus arteriosus, necrotising enterocolitis, intraventricular haemorrhage grades 3 and 4, retinopathy of prematurity stage 3, time to full feeds and length of hospital stay

Starting date

December 2011

Contact information

Alberto Estay, MD

Notes

Expected completion date: June 2013
NCT02396693

Trial name or title

Successful Extubation and Non‐invasive Ventilation in Preterm ≤ 1500 grams

Methods

Randomised controlled trial

Participants

Infants 26 to 34 weeks, 500 to 1500 grams, with diagnosis of RDS and first elective extubation

Interventions

NIPPV (unspecified device) vs bubble CPAP

Outcomes

Success rate of extubation, total duration of oxygen use, mechanical ventilation and bronchopulmonary dysplasia (BPD), days of oxygen use, mechanical ventilation

Starting date

August 2012

Contact information

Cintia Johnston

Notes

Completed. No publication identified
Shi 2013

Trial name or title

Nasal Intermittent Positive Pressure Ventilation in Newborn Infants With Respiratory Distress Syndrome

Methods

Randomised controlled trial

Participants

Inclusion criteria:

  • Newborn infants with birth weight > 500 grams

  • Gestational age > 24 completed weeks

  • Intention to manage the infant with non‐invasive respiratory support (i.e. no endotracheal tube), when the infant is within the first 7 days of life and has never been intubated or has received < 24 hours of total cumulative intubated respiratory support; or the infant is within the first 28 days of life, has been managed with intubated respiratory support for ≥ 24 hours and is a candidate for extubation followed by non‐invasive respiratory support

  • No known lethal congenital anomaly or genetic syndromes

  • Signed parental informed consent

Exclusion criteria:

  • Considered non‐viable by clinician (decision not to administer effective therapies)

  • Life‐threatening congenital abnormalities including congenital heart disease (excluding patent ductus arteriosus)

  • Infants known to require surgical treatment

  • Abnormalities of upper and lower airways

  • Neuromuscular disorders

  • Infants > 28 days old who continue to require mechanical ventilation with an endotracheal tube

Interventions

NIPPV via Bird ventilator or NCPAP (after extubation or as a primary mode of respiratory support)

Outcomes

Primary: incidence of mechanical ventilation via endotracheal tube after non‐invasive respiratory support within 7 days

Secondary: overall clinical outcomes at 7 days', 28 days' and 36 weeks' postmenstrual age

Starting date

January 2008

Contact information

Yuan Shi, MD

Notes

Expected completion date: December 2011; information last updated on Clinicaltrials.gov 17 December 2012. Part of the study population could be included in an updated version of this review.

Victor 2011

Trial name or title

A Randomised Controlled Trial of Nasal Biphasic Positive Airway Pressure vs Nasal Continuous Positive Airway Pressure Following Extubation in Infants Less Than 30 Weeks’ Gestation: Study Protocol for a Randomised Controlled Trial

Methods

Unblinded multi‐centre randomised trial

Participants

Infants born before 30 weeks’ gestation and less than 2 weeks old. Infants with congenital abnormalities and severe intraventricular haemorrhage will be excluded. 540 infants admitted to neonatal centres in England will be randomised at the time of first extubation attempt.

Interventions

Unblinded multi‐centre randomised trial comparing NCPAP vs n‐BiPAP

Outcomes

Primary aim of this study is to compare rate of extubation failure within 48 hours after first attempt at extubation.

Secondary aims are to compare effects of n‐BiPAP and n‐CPAP on the following outcomes.
• Maintenance of successful extubation for 7 days post extubation
• Oxygen requirement at 28 days of age and at 36 weeks’ postmenstrual age
• Total days on ventilator, n‐CPAP/n‐BiPAP
• Number of ventilator days after first extubation attempt
• pH and partial pressure of carbon dioxide in the first postextubation blood gas
• Duration of hospital stay
• Rate of abdominal distension requiring cessation of feeds
• Rates of apnoea and bradycardia
• Age at transfer back to referral centre in days

Starting date

Contact information

[email protected]

1 Ward 68, 2nd Floor, St Mary’s Hospital for Women and Children, Manchester, UK M13 9WL

Notes

Trial registration number: ISRCTN: ISRCTN18921778

http://www.trialsjournal.com/content/12/1/257 TRIALS

BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; FiO2: fraction of inspired oxygen; n‐BiPAP: noninvasive cycled respiratory support mechanism; n‐CPAP/NCPAP: nasal continuous positive airway pressure; NIPPV: nasal intermittent positive pressure ventilation; PaCO2: partial pressure of carbon dioxide in arterial blood; pCO2: partial pressure of carbon dioxide; RDS: respiratory distress syndrome.

Data and analyses

Open in table viewer
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]
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 1 Respiratory failure post extubation.

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]
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 2 Endotracheal re‐intubation.

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

Open in table viewer
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]
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 1 Abdominal distension leading to cessation of feeds.

2 Gastrointestinal perforation Show forest plot

5

1066

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.60, 1.48]
Analysis 2.2
Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 2 Gastrointestinal perforation.

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

3 Necrotising enterocolitis Show forest plot

6

1214

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.64, 1.19]
Analysis 2.3
Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 3 Necrotising enterocolitis.

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

Open in table viewer
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]
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 1 Chronic lung disease (oxygen supplementation at 36 weeks).

2 Air leaks Show forest plot

6

1229

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.28, 0.82]
Analysis 3.2
Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 2 Air leaks.

Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 2 Air leaks.
Open in table viewer
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]
Analysis 4.1
Comparison 4 NIPPV versus NCPAP and mortality, Outcome 1 Death before discharge.

Comparison 4 NIPPV versus NCPAP and mortality, Outcome 1 Death before discharge.
Open in table viewer
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]
Analysis 5.1
Comparison 5 NIPPV versus NCPAP and duration of hospital admission, Outcome 1 Duration of hospital admission (days).

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

Open in table viewer
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]
Analysis 6.1
Comparison 6 NIPPV versus NCPAP and apnoea, Outcome 1 Rates of apnoea (episodes/24 h).

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

Open in table viewer
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]
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 1 Respiratory failure post extubation.

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]
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 2 Endotracheal re‐intubation during the week post extubation.

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]
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 3 Abdominal distension requiring cessation of feeds.

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]
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 4 Gastrointestinal perforation.

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]
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 5 Necrotising enterocolitis.

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]
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 6 Chronic lung disease (oxygen supplementation at 36 weeks).

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]
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 7 Pulmonary air leak.

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]
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 8 Rates of apnoea (episodes/24 h).

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]
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 9 Duration of hospitalisation (days).

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

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

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]
Open in table viewer
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]
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 1 Respiratory failure post extubation.

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]
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 2 Endotracheal re‐intubation during the week post extubation.

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]
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 3 Abdominal distension requiring cessation of feeds.

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]
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 4 Gastrointestinal perforation.

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]
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 5 Necrotising enterocolitis.

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]
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 6 Chronic lung disease (oxygen supplementation at 36 weeks).

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]
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 7 Pulmonary air leak.

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]
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 8 Rates of apnoea (episodes/24 h).

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]
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 9 Duration of hospitalisation (days).

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

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

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]

Study flow diagram: review update.
Figuras y tablas -
Figure 1

Study flow diagram: review update.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

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

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Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 1 Respiratory failure post extubation.
Figuras y tablas -
Analysis 1.1

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

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Comparison 1 NIPPV versus NCPAP to prevent extubation failure, Outcome 2 Endotracheal re‐intubation.
Figuras y tablas -
Analysis 1.2

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

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

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

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

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

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Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 2 Gastrointestinal perforation.
Figuras y tablas -
Analysis 2.2

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

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Comparison 2 NIPPV versus NCPAP and gastrointestinal complications, Outcome 3 Necrotising enterocolitis.
Figuras y tablas -
Analysis 2.3

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

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

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

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Comparison 3 NIPPV versus NCPAP to improve pulmonary outcomes, Outcome 2 Air leaks.
Figuras y tablas -
Analysis 3.2

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

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Comparison 4 NIPPV versus NCPAP and mortality, Outcome 1 Death before discharge.
Figuras y tablas -
Analysis 4.1

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

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

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

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

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 1 Respiratory failure post extubation.
Figuras y tablas -
Analysis 7.1

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

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

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

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

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 4 Gastrointestinal perforation.
Figuras y tablas -
Analysis 7.4

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 5 Necrotising enterocolitis.
Figuras y tablas -
Analysis 7.5

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

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

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 7 Pulmonary air leak.
Figuras y tablas -
Analysis 7.7

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

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

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 9 Duration of hospitalisation (days).
Figuras y tablas -
Analysis 7.9

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

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Comparison 7 NIPPV versus NCPAP (synchronised vs non‐synchronised), Outcome 10 Death before discharge.
Figuras y tablas -
Analysis 7.10

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 1 Respiratory failure post extubation.
Figuras y tablas -
Analysis 8.1

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

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

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

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

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 4 Gastrointestinal perforation.
Figuras y tablas -
Analysis 8.4

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 5 Necrotising enterocolitis.
Figuras y tablas -
Analysis 8.5

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

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

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 7 Pulmonary air leak.
Figuras y tablas -
Analysis 8.7

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

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

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 9 Duration of hospitalisation (days).
Figuras y tablas -
Analysis 8.9

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

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Comparison 8 NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV), Outcome 10 Death before discharge.
Figuras y tablas -
Analysis 8.10

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

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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).

Figuras y tablas -
Summary of findings for the main comparison. NIPPV versus NCPAP
Ir a la tabla de la revisión
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]
Figuras y tablas -
Comparison 1. NIPPV versus NCPAP to prevent extubation failure
Ir a la tabla de la revisión
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]
Figuras y tablas -
Comparison 2. NIPPV versus NCPAP and gastrointestinal complications
Ir a la tabla de la revisión
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]
Figuras y tablas -
Comparison 3. NIPPV versus NCPAP to improve pulmonary outcomes
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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]
Figuras y tablas -
Comparison 4. NIPPV versus NCPAP and mortality
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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]
Figuras y tablas -
Comparison 5. NIPPV versus NCPAP and duration of hospital admission
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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]
Figuras y tablas -
Comparison 6. NIPPV versus NCPAP and apnoea
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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]
Figuras y tablas -
Comparison 7. NIPPV versus NCPAP (synchronised vs non‐synchronised)
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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]
Figuras y tablas -
Comparison 8. NIPPV versus NCPAP (ventilator‐generated NIPPV vs bilevel NIPPV)
Ir a la tabla de la revisión