Ventilación de alta frecuencia no invasiva para neonatos con dificultad respiratoria
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012712.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 02 mayo 2024see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neonatología
- Copyright:
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- Copyright © 2024 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
- This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial Licence , which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Autores
Contributions of authors
Mohamed E Abdel‐Latif conceived and wrote the draft of the review. He contributed independently (and equally) to study selection, data extraction, risk of bias assessment, data analysis and evidence synthesis.
Olive Tan translated, completed characteristics of included studies, risk of bias assessments and extracted data for Chinese language articles.
Michelle Fiander wrote search strategies, methods, results of search, and developed the PRISMA diagram.
David A Osborn contributed independently (and equally) to study selection, data extraction, risk of bias assessment, data analysis and evidence synthesis.
All review authors provided feedback on the content of the draft and the final manuscript.
We acknowledge Jocelyn Chan and Lisa J Jones' contribution to the protocol (Chan 2017). Jocelyn Chan helped develop the first draft of the protocol.
Sources of support
Internal sources
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None., Other
None.
External sources
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Vermont Oxford Network, USA
Cochrane Neonatal Reviews are produced with support from Vermont Oxford Network, a worldwide collaboration of health professionals dedicated to providing evidence‐based care of the highest quality for newborn infants and their families.
Declarations of interest
Mohamed E Abdel‐Latif is an Associate Editor with the Cochrane Neonatal Group, but was not involved in the editorial acceptance or assessment of this review.
Olive Tan does not have any interests to disclose at this time.
Michelle Fiander is an Information Specialist and Managing Editor with the Cochrane Neonatal Group, but was not involved in the editorial acceptance or assessment of this review.
David A Osborn is a Senior Editor with the Cochrane Neonatal Group, but was not involved in the editorial acceptance or assessment of this review.
Acknowledgements
We would like to thank the following authors who contributed to the previous version of the protocol: Jocelyn Chan and Lisa J Jones (Chan 2017).
The methods section of the review is based on a standard template used by Cochrane Neonatal.
We would like to thank Cochrane Neonatal: Jane Cracknell, Managing Editor; Roger Soll, Co‐coordinating Editor; and Bill McGuire, Co‐coordinating Editor, who provided editorial and administrative support.
We want to thank Assistant Professor Rida Ali, Bahria University Health Sciences, Pakistan (Ali 2023), and Assistant Professor Ashraf Mohamed Ibrahim, Egypt (El Ashker 2022), for providing further information about their studies on request.
We want to thank Ms Lin Han, RN/RM, Centenary Hospital for Women and Children, Australia for helping translate Chinese studies to English.
We are grateful to the following peer reviewers for their time and comments: Jen Jen Leong Consultant Neonatologist, Sunway Medical Centre Penang, Malaysia; Marc‐Olivier Deguise, Children's Hospital of Eastern Ontario and University of Ottawa, Canada. Marc‐Olivier Deguise has declared that he is an author of the Additional Reference Lemyre 2023.
Open‐access publishing was facilitated by the Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.
We would also like to thank Anne Lethaby, Cochrane Central Production Service, for copy editing this review.
Version history
| Published | Title | Stage | Authors | Version |
| 2024 May 02 | Non‐invasive high‐frequency ventilation in newborn infants with respiratory distress | Review | Mohamed E Abdel-Latif, Olive Tan, Michelle Fiander, David A Osborn | |
| 2017 Jul 09 | Non‐invasive high‐frequency ventilation in newborn infants with respiratory distress | Protocol | Jocelyn Chan, Lisa J Jones, David A Osborn, Mohamed E Abdel‐Latif | |
Differences between protocol and review
We made the following changes to the published protocol (Chan 2017):
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We replaced the term 'respiratory support' in the objective section with 'invasive ventilation via an ET tube or other non‐invasive ventilation methods' based on the reviewers' feedback.
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We updated the methods section as the methods for Cochrane reviews have evolved.
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We removed blinding as a criterion in the sensitivity analysis for objective outcomes (e.g. death) as the intervention is unlikely to be able to be adequately blinded. However, blinding was included in the sensitivity analyses for subjective outcomes (such as endotracheal intubation and endotracheal reintubation).
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We searched additional databases: Epistemonikos and the Chinese language articles from China/Asia On Demand (CAOD).
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The review has been expanded to include additional ventilatory modalities, including (i) invasive neurally adjusted ventilatory assist (iNAVA) and (ii) non‐invasive neurally adjusted ventilatory assist (nNAVA).
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We added more secondary outcomes, including (i) death or chronic lung disease at 36 weeks' postmenstrual age; (ii) necrotising enterocolitis (NEC); (iii) discharge on home oxygen; (iv) spontaneous intestinal perforation; (v) duration of respiratory support (days); and (vi) duration of oxygen therapy (days).
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Additional subgroup comparisons were added, including (i) the interface used to deliver nHFV and (ii) modes of nHFV, including oscillatory, percussive, and jet.
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We excluded cross‐over trials from the review as outcomes required longitudinal follow‐up of parallel groups, and there is a likelihood of carry‐over in some outcomes as described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2023).
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We restated the types of participants to reflect better the review intention from: 'Preterm and term newborn infants with or at risk of respiratory distress requiring ventilation as initial support, following extubation or as a rescue mode' to 'We included term and preterm infants with or at risk of respiratory distress in their initial hospitalisation.'
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We did not report 'Failure of respiratory support or failure of extubation' in the SoF table as it was either not reported or grossly under‐reported by trials. 'Endotracheal intubation or reintubation' was reliably reported by trials, so it remains in the SoF table.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans; Infant, Newborn;
PICO
Study flow diagram. Updated search April 2023.
Studies included in the review were categorised by comparison group.
CV denotes invasive conventional ventilation; InSurE: Intubate, Surfactant, Extubate; HFV: invasive high‐frequency ventilation; HHHFNC: Heated humidified high‐flow nasal cannula; NAVA: invasive Neurally Adjusted Ventilatory Assist; nCPAP: nasal continuous positive airway pressure; nHFV: non‐invasive high‐frequency ventilation; nIPPV: non‐invasive intermittent positive‐pressure ventilation
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Funnel plot: Trials comparing nHFV with nCPAP for respiratory support following planned extubation: Outcome 6.2 Endotracheal reintubation. Current studies are depicted as blue, and imputed studies are red. Egger test P = 0.002
Funnel plot: Trials comparing nHFV with nCPAP for respiratory support following planned extubation: Outcome 6.7 Chronic lung disease at 36 weeks. Current studies are depicted as blue, and imputed studies are red. Egger test = 0.050
Comparison 1: Initial respiratory support: nHFV vs invasive respiratory therapy, Outcome 1: Mortality before hospital discharge
Comparison 1: Initial respiratory support: nHFV vs invasive respiratory therapy, Outcome 2: Duration of respiratory support, days
Comparison 1: Initial respiratory support: nHFV vs invasive respiratory therapy, Outcome 3: Chronic lung disease at 36 weeks
Comparison 1: Initial respiratory support: nHFV vs invasive respiratory therapy, Outcome 4: Pulmonary air leak syndromes
Comparison 1: Initial respiratory support: nHFV vs invasive respiratory therapy, Outcome 5: Length of hospital stay, days
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 1: Mortality before hospital discharge
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 2: Endotracheal intubation
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 3: Trauma to the nostrils and upper airway
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 4: Failure of respiratory support
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 5: Duration of respiratory support, days
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 6: Duration of oxygen therapy, days
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 7: Chronic lung disease at 36 weeks
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 8: Death or chronic lung disease at 36 weeks
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 9: Patent ductus arteriosus
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 10: Pulmonary air leak syndromes
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 11: Proven sepsis
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 12: Necrotising enterocolitis
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 13: Necrotising enterocolitis (NEC) (Bell stage ≥ 2)
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 14: Spontaneous intestinal perforation
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 15: Intraventricular haemorrhage, any
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 16: Intraventricular haemorrhage, Papile grade 3/4
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 17: Periventricular leukomalacia
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 18: Retinopathy of prematurity, any
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 19: Retinopathy of prematurity, stage ≥ 3
Comparison 2: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 20: Length of hospital stay, days
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 1: Mortality before hospital discharge
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 2: Endotracheal intubation
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 3: Failure of respiratory support
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 4: Chronic lung disease at 36 weeks
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 5: Death or chronic lung disease at 36 weeks
Comparison 3: Initial respiratory support: nHFV vs nCPAP ‐ subgroup analyses, Outcome 6: Intraventricular haemorrhage, Papile grade 3/4
Comparison 4: Initial respiratory support: nHFV vs nIPPV ‐ subgroup analyses, Outcome 1: Mortality before hospital discharge
Comparison 4: Initial respiratory support: nHFV vs nIPPV ‐ subgroup analyses, Outcome 2: Endotracheal intubation
Comparison 4: Initial respiratory support: nHFV vs nIPPV ‐ subgroup analyses, Outcome 3: Failure of respiratory support
Comparison 4: Initial respiratory support: nHFV vs nIPPV ‐ subgroup analyses, Outcome 4: Chronic lung disease at 36 weeks
Comparison 4: Initial respiratory support: nHFV vs nIPPV ‐ subgroup analyses, Outcome 5: Intraventricular haemorrhage, Papile grade 3/4
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 1: Mortality before hospital discharge
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 2: Endotracheal intubation
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 3: Failure of respiratory support
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 4: Chronic lung disease at 36 weeks
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 5: Death or chronic lung disease at 36 weeks
Comparison 5: Initial respiratory support: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 6: Intraventricular haemorrhage, Papile grade 3/4
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 1: Mortality before hospital discharge
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 2: Endotracheal reintubation
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 3: Trauma to the nostrils and upper airway
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 4: Failure of extubation
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 5: Duration of respiratory support, days
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 6: Duration of oxygen therapy, days
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 7: Chronic lung disease at 36 weeks
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 8: Death or chronic lung disease at 36 weeks
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 9: Patent ductus arteriosus
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 10: Pulmonary air leak syndromes
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 11: Proven sepsis
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 12: Necrotising enterocolitis
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 13: Necrotising enterocolitis, Bell stage ≥ 2
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 14: Intraventricular haemorrhage, any
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 15: Intraventricular haemorrhage, Papile grade 3/4
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 16: Periventricular leukomalacia
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 17: Retinopathy of prematurity, any
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 18: Retinopathy of prematurity, stage ≥ 3
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 19: Length of hospital stay, days
Comparison 6: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities, Outcome 20: Neurodevelopmental disability at least 18 months' postnatal age or later
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 1: Mortality before hospital discharge
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 2: Endotracheal reintubation
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 3: Failure of extubation
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 4: Chronic lung disease at 36 weeks
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 5: Death or chronic lung disease at 36 weeks
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 6: Intraventricular haemorrhage, Papile grade 3/4
Comparison 7: Respiratory support following planned extubation: nHFV vs nCPAP ‐ subgroup analyses, Outcome 7: Neurodevelopmental disability at least 18 months' postnatal age or later
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 1: Mortality before hospital discharge
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 2: Endotracheal reintubation
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 3: Chronic lung disease at 36 weeks
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 4: Death or chronic lung disease at 36 weeks
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 5: Intraventricular haemorrhage, Papile grade 3/4
Comparison 8: Respiratory support following planned extubation: nHFV vs nIPPV ‐ subgroup analyses, Outcome 6: Neurodevelopmental disability at least 18 months' postnatal age or later
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 1: Mortality before hospital discharge
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 2: Endotracheal reintubation
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 3: Failure of extubation
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 4: Chronic lung disease at 36 weeks
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 5: Death or chronic lung disease at 36 weeks
Comparison 9: Respiratory support following planned extubation: nHFV vs other non‐invasive respiratory therapy modalities ‐ sensitivity analyses, Outcome 6: Intraventricular haemorrhage, Papile grade 3/4
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 1: Mortality before hospital discharge
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 2: Endotracheal intubation
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 3: Failure of respiratory support
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 4: Duration of oxygen therapy, days
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 5: Chronic lung disease at 36 weeks
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 6: Pulmonary air leak syndromes
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 7: Necrotising enterocolitis
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 8: Spontaneous intestinal perforation
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 9: Intraventricular haemorrhage, Papile grade 3/4
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 10: Periventricular leukomalacia
Comparison 10: Respiratory support following initial non‐invasive respiratory support failure: nHFV vs nIPPV, Outcome 11: Retinopathy of prematurity, stage ≥ 3
| nHFV compared to invasive respiratory therapy for initial respiratory support | ||||||
| Patient or population: preterm infants with respiratory distress | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Invasive respiratory therapy | nHFV | |||||
| Mortality before hospital discharge | 150 per 1000 | 101 per 1000 | RR 0.67 | 80 | ⊕⊝⊝⊝ | |
| Endotracheal intubation or reintubation To discharge | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Chronic lung disease | 67 per 1000 | 25 per 1000 | RR 0.38 | 180 | ⊕⊝⊝⊝ | |
| Death or chronic lung disease | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Intraventricular haemorrhage, Papile grade 3/4 | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Neurodevelopmental disability | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for high risk of bias 2 Downgraded two levels for imprecision due to a single small study and wide confidence intervals 3 Downgraded two levels for serious imprecision due to few events, and confidence intervals include appreciable benefit or harm | ||||||
| nHFV compared to nCPAP used for initial respiratory support | ||||||
| Patient or population: newborn (term* and preterm) infants with respiratory distress for initial respiratory support | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| nCPAP | nHFV | |||||
| Mortality before hospital discharge | 34 per 1000 | 34 per 1000 | RR 1.00 | 531 | ⊕⊝⊝⊝ | |
| Endotracheal intubation To discharge | 165 per 1000 | 86 per 1000 | RR 0.52 | 571 | ⊕⊕⊝⊝ | Subgroup analyses according to gestation, nHFV mean airway pressure, and nHFV frequency found no statistically significant subgroup differences. |
| Chronic lung disease | 91 per 1000 | 123 per 1000 | RR 1.35 (0.80 to 2.27) | 481 | ⊕⊕⊝⊝ | |
| Death or chronic lung disease | 59 per 1000 | 147 per 1000 | RR 2.50 | 68 | ⊕⊕⊝⊝ | |
| Intraventricular haemorrhage, Papile grade 3/4 | 19 per 1000 | 22 per 1000 | RR 1.17 | 531 | ⊕⊕⊝⊝ | |
| Neurodevelopmental disability | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for risk of bias 2 Downgraded two levels for serious imprecision because of wide confidence intervals and few events 3 Downgraded one level for imprecision due to confidence intervals, including appreciable benefit or harm 4 Single small study 5 Subjective outcome measure * A single study enroled 46 term infants (De La Roque 2011). | ||||||
| nHFV compared to nIPPV used for initial respiratory support | ||||||
| Patient or population: preterm infants with respiratory distress for initial respiratory support | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| NIPPV | nHFV | |||||
| Mortality before hospital discharge | 163 per 1000 | 303 per 1000 | RR 1.86 | 84 | ⊕⊕⊝⊝ | |
| Endotracheal intubation To discharge | 144 per 1000 | 192 per 1000 | RR 1.33 (0.76 to 2.34) | 228 | ⊕⊕⊝⊝ | |
| Chronic lung disease | 276 per 1000 | 174 per 1000 | RR 0.63 (0.42 to 0.95) | 307 | ⊕⊕⊝⊝ | |
| Death or chronic lung disease | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Intraventricular haemorrhage, Papile grade 3/4 | See comment | See comment | Not estimable | 36 | ⊕⊝⊝⊝ | No events |
| Neurodevelopmental disability | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for risk of bias 2 Downgraded one level for imprecision due to wide confidence intervals 3 Downgraded two levels for serious imprecision due to a single small study with no/few events 4 Subjective outcome measure | ||||||
| nHFV compared to HFNC for initial respiratory support | ||||||
| Patient or population: preterm infants with respiratory distress for initial respiratory support | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| HFNC | nHFV | |||||
| Mortality before hospital discharge | See comment | See comment | Not estimable | 37 | ⊕⊝⊝⊝ | No events |
| Endotracheal intubation or reintubation To discharge | 100 per 1000 | 294 per 1000 | RR 2.94 (0.65 to 13.27) | 37 | ⊕⊝⊝⊝ | |
| Chronic lung disease | 300 per 1000 | 354 per 1000 | RR 1.18 (0.46 to 2.98) | 37 | ⊕⊝⊝⊝ | |
| Death or chronic lung disease | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Intraventricular haemorrhage, Papile grade 3/4 | See comment | See comment | Not estimable | 37 | ⊕⊝⊝⊝ | No events |
| Neurodevelopmental disability | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for risk of bias 2 Downgraded two levels for serious imprecision due to a single small study with few/no events 3 Subjective outcome measure | ||||||
| nHFV compared to nCPAP for respiratory support following planned extubation | ||||||
| Patient or population: ventilated preterm infants with planned extubation | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| NCPAP | nHFV | |||||
| Mortality before hospital discharge | 32 per 1000 | 30 per 1000 | RR 0.92 | 1427 | ⊕⊕⊕⊝ | |
| Endotracheal reintubation To discharge | 306 per 1000 | 128 per 1000 | RR 0.42 | 1897 | ⊕⊕⊝⊝ | Subgroup analyses according to gestation, nHFV mean airway pressure, and nHFV frequency found no statistically significant subgroup differences. |
| Chronic lung disease | 284 per 1000 | 222 per 1000 | RR 0.78 | 1829 | ⊕⊕⊝⊝ | |
| Death or chronic lung disease | 394 per 1000 | 355 per 1000 | RR 0.90 | 966 | ⊕⊕⊕⊝ | |
| Intraventricular haemorrhage, Papile grade 3/4 | 116 per 1000 | 93 per 1000 | RR 0.80 | 1117 | ⊕⊕⊕⊝ | |
| Neurodevelopmental disability | 211 per 1000 | 194 per 1000 | RR 0.92 (0.37, 2.29) | 74 | ⊕⊝⊝⊝ | |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for imprecision because of wide confidence intervals 2 Downgraded one level for risk of bias 3 Downgraded one level for publication bias 4 Subjective outcome measure 5 Downgraded two levels for serious imprecision due to a single study with few events, and confidence intervals included appreciable benefit or harm | ||||||
| nHFV compared to nIPPV for respiratory support following planned extubation | ||||||
| Patient or population: ventilated preterm infants with planned extubation | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| NIPPV | nHFV | |||||
| Mortality before hospital discharge | 12 per 1000 | 22 per 1000 | RR 1.83 | 984 | ⊕⊕⊝⊝ | |
| Endotracheal reintubation To discharge | 179 per 1000 | 123 per 1000 | RR 0.69 | 1364 | ⊕⊕⊕⊝ | Subgroup analyses according to gestation, nHFV mean airway pressure, and nHFV frequency found no statistically significant subgroup differences. |
| Chronic lung disease | 336 per 1000 | 296 per 1000 | RR 0.88 | 1236 | ⊕⊕⊕⊝ | |
| Death or chronic lung disease | 387 per 1000 | 356 per 1000 | RR 0.92 | 1070 | ⊕⊕⊕⊝ | |
| Intraventricular haemorrhage, Papile grade 3/4 | 115 per 1000 | 90 per 1000 | RR 0.78 | 1162 | ⊕⊕⊕⊝ | |
| Neurodevelopmental disability | 222 per 1000 | 196 per 1000 | RR 0.88 | 72 | ⊕⊕⊝⊝ | |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded one level for risk of bias 2 Downgraded one level for imprecision due to confidence intervals, including appreciable benefit or harm 3 Subjective outcome measure | ||||||
| nHFV compared to nIPPV following failure of initial non‐invasive respiratory support | ||||||
| Patient or population: ventilated preterm infants with failure of initial non‐invasive respiratory support | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| NIPPV | nHFV | |||||
| Mortality before hospital discharge | 43 per 1000 | 63 per 1000 | RR 1.44 | 39 | ⊕⊕⊝⊝ | |
| Endotracheal intubation To discharge | 304 per 1000 | 374 per 1000 | RR 1.23 | 39 | ⊕⊝⊝⊝ | |
| Chronic lung disease | 739 per 1000 | 747 per 1000 | RR 1.01 | 39 | ⊕⊕⊝⊝ | |
| Death or chronic lung disease | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| Intraventricular haemorrhage, Papile grade 3/4 | 43 per 1000 | 20 per 1000 | RR 0.47 | 39 | ⊕⊕⊝⊝ | |
| Neurodevelopmental disability | See comment | See comment | Not estimable | 0 | See comment | Not reported |
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group certainty of evidence | ||||||
| 1 Downgraded two levels for serious imprecision due to a single small study with few events, and confidence intervals included appreciable benefit or harm 2 Downgraded one level for risk of bias (unblinded study/subjective outcome measure) 3 A single event of Intraventricular haemorrhage, Papile grade 3/4, was reported amongst the nasal intermittent positive pressure ventilation (nIPPV) group. | ||||||
| Study | Country/total participants | Eligibility criteria | Gestational age weeks/birthweight g | Intervention group | Control group | Interface (in both intervention and control groups) | |||
| Intervention group | Control group | Mode | Settings | Mode | Settings | ||||
| China 80 | RDS | 30.46 +/‐ 1.35 weeks | 30.37 +/‐ 1.31 weeks | nHFOV with surfactant | Ventilator: Stephanie, Servo‐a MAP: 10 to 12 cm H2O Frequency: 12 to 15 Hz Amplitude: 30 to 45 cm H2O | Invasive respiratory support (conventional mechanical ventilation) with surfactant | Ventilator: Maquet PIP: 15 to 25 cm H2O PEEP: PEEP 4 to 6 cm H2O Respiratory Rate: 40 to 60 bpm | Not reported | |
| China 100 | RDS | 31.05 +/‐ 1.26 (range 25 to 35) weeks | 31.02+/‐1.24 (range 28 to 35) weeks | nHFOV | Ventilator: Medin CNO, Germany MAP: 5 to 10 cm H2O Frequency: 7 to 10 Hz Amplitude: 4 to 10 cm H2O | Invasive respiratory support (conventional mechanical ventilation) | Ventilator: Drager Babylog VN500 PIP: 15 to 25 cm H2O PEEP: 4 to 8 cm H2O Respiratory rate: 30 to 40 bpm | Not reported | |
| bpm: breaths per minute; hz: hertz; MAP: mean airway pressure; nHFOV: non‐invasive high‐frequency oscillatory ventilation; PEEP: positive end‐expiratory pressure; PIP: positive inspiratory pressure; RDS: respiratory distress syndrome | |||||||||
| Study | Country total participants | Gestation and weight eligibility criteria | Gestational age weeks/birthweight g | Intervention group | Control group | Interface (in both intervention and control groups) | |||
| Intervention group | Control group | Mode | Settings | Mode | Settings | ||||
| France 46 | ≥ 37 weeks ≥ 2000 g | 38 +/‐ 0.5 weeks 3004 +/‐ 116 g | 37 +/‐ 0.5 weeks 3375 +/‐ 160 g | nHFPV | Ventilator: Percussionaire MAP: 5 cm H2O Frequency: 5 Hz Amplitude: 2 to 35 cm H2O | nCPAP | Ventilator: Babylog 8000 PEEP: 5 cm H2O | Single heated humidified nasal probe | |
| Egypt 60 | GA between 28 + 0 and 33 + 6 weeks | Not stated | Not stated | nHFOV | Ventilator: SLE5000, UK MAP: NS Frequency: NS Amplitude: NS | nCPAP | Ventilator: Medin CNO, medin Medical Innovations GmbH, Olching, Germany) or (SLE 1000, SLE Limited, UK) PEEP: NS | nCPAP via binasal prongs nHFOV via nasopharyngeal tube | |
| Iran 68 | 30 to 36 + 6/7 weeks | 33 (IQR 30–34) weeks 1959 (613) g | 33 (IQR 31–35) weeks 2161 (764) g | nHFOV | Ventilator: Fabian MAP: 8 cmH2O Frequency: 10 to 20 Hz Amplitude: 20 cm H2O | nCPAP | Ventilator: Fabian PEEP: 6 to 7 cm H2O | Short binasal prongs | |
| Iran 124 | 28 to 34 weeks | 31.08 ± 2.9 weeks 1486 ± 470 g | 31.07 ± 2.8 weeks 1506 ± 490 g | nHFOV | Ventilator: CNO driver MAP: 8 cm H2O Frequency: 5 Hz Amplitude: 3 to 7 cm H2O | nCPAP | Ventilator: Flow‐driver (Sindi NCPAP driver) PEEP: 4 to 8 cm H2O | Short binasal prongs | |
| China 74 | RDS | NR | NR | nHFOV | Ventilator: Medin CNO MAP: 8 to 12 cm H2O Frequency: 7 to 12 Hz Amplitude: 2 to 3 times MAP with visible chest oscillation | nCPAP | PEEP: 5 to 7 cm H2O | Not reported | |
| Turkey 37 | < 32 weeks | Median 29 (range 27 to 34) weeks Median 1250 (range 800 to 2240) g | Median 28 (range 26 to 32) weeks Median 1240 (range 580 to 2010) g | nHFOV | Ventilator: Babylog 8000 MAP: 6 cm H2O Frequency: 10 Hz Amplitude: deltaP 100% | nCPAP | Ventilator: bubble CPAP system PEEP: 5 to 6 cm H2O | Short binasal prongs | |
| China 102 | 26 to 42 weeks | 26 to 42 (34.52 +/‐ 2.98) weeks | 26‐39 (34.25 +/‐ 3.14) | nHFOV | Ventilator: SLE 5000 MAP: 8 to 12 cm H20 Frequency: 7 to 12 Hz Amplitude not reported | nCPAP | Ventilator: NV8 PEEP: 5 to 7 cm H2O | Not reported | |
| China 340 | 26 to 33 + 6/7 weeks | 30.6 +/‐ 1.7 weeks 1564 +/‐ 367 g | 30.9 +/‐ 1.8 weeks 1582 +/‐ 343 g | nHFOV | Ventilator: CNO MAP: 6 [6 to 10] cm H2O Frequency: 8 [8 to 12] Hz Amplitude: level 7 (range 7 to 10) or Ventilator: SLE5000 MAP: 6 [6 to 10] cm H2O Frequency: 8 [8 to 12] Hz Amplitude: 20 [20 to 35) cm H2O | nCPAP | Ventilator: CNO or SLE5000 PEEP: 6 [6 to 8] cm H2O | Short binasal prongs | |
| China 65 | 28 to 35 weeks | 33.5 ± 1.5 weeks 1790 ± 330 g | 34.2 ± 1.6 weeks 1840 ± 420 g | nHFOV | Ventilator: SLE Baby 5000, Germany MAP: 6 to 12 cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times MAP | BP‐CPAP (considered to be equivalent to nIPPV) | Ventilator: Fabian, Swiss PIP: 12 to 15 cm H2O PEEP: 5 cm H2O Rate: | Short binasal prongs | |
| China 82 | < 37 weeks | 33.2 ± 1.4 weeks 1820 ± 330 g | 33.5 ± 1.5 weeks 1840 ± 410 g | nHFOV with thin‐catheter surfactant | Ventilator: SLE5000 MAP: 8 cm H2O Frequency: 7 to 12 Hz Amplitude: 16 to 24 cm H2O | BiPAP (considered to be equivalent to nIPPV) with thin‐catheter surfactant | Ventilator: Fabian PIP: 12 to 15 cm H2O PEEP: 5 cm H2O Rate: 30 to 40 bpm | Not reported | |
| China 60 | RDS | 30.73 +/‐ 1.31 weeks | 30.46 +/‐ 1.35 weeks | nHFOV | Ventilator: Sophie MAP: 8 to 12 cm H2O Frequency: 10 to 15 Hz Amplitude: 30 to 40 cm | nIPPV | Ventilator: Sophie PIP: 15 to 25 cm H20 PEEP: 4 to 6 cm H20 | Not reported | |
| China 120 | < 31 weeks < 1500 g | 28.56 ± 1.23 weeks 1150 ± 135 g | 28.71 ± 1.18 weeks 1188 ± 142 g | nHFOV | Not reported | nIPPV | Not reported | Not reported | |
| Pakistan 48 | 27 to 34 weeks | 29.96 ± 2.38 weeks 1347 ± 458 g | 43.58 ± 61.03 weeks 1672 ± 534 g | nHFOV with surfactant administration via InSurE | Ventilator: CNO Medin MAP: 6 (range 6‐10) cm H2O Frequency: 8 (range 8‐12) Hz Amplitude: 7 (range 7‐10) cm H2O | nIPPV with surfactant administration via InSurE | Ventilator: CNO Medin PIP: 15 (range 1‐25) H2O PEEP: 6 (range 1‐8) cm H2O Rate: 40 (range 5‐60) bpm Inspiratory time (IT): 0.40 s | Nasal mask | |
| China 60 | 28 to 34 weeks | 31.38 ± 1.60 weeks 1656 ± 423 g | 31.78 ± 1.55 weeks 1572 ± 370 g | nHFOV with non‐invasive surfactant | Ventilator: Leoni Plus MAP: 6 to 12 cm H2O Frequency: 6 to 12 Hz Amplitude: 2 times MAP with visible chest oscillation | nIPPV with non‐invasive surfactant | Ventilator: Leoni Plus PIP: 15 to 25 cm H2O PEEP: 4 to 6 cm H2O Rate: 15 to 30 bpm | Not reported | |
| Turkey 37 | < 32 weeks | Median 29 (range 27 to 34) weeks Median 1250 (range 800 to 2240) g | Median 28 (26 to 32) weeks Median 1130 (range 530 to 2550) g | nHFOV | Ventilator: Babylog 8000 MAP: 6 cm H2O Frequency: 10 Hz Amplitude: deltaP 100% | nIPPV | Ventilator: Babylog 8000 PIP: 15 to 20 cm H2O PEEP: 5 to 6 cm H2O Rate: 25 to 30 bpm | Short binasal prongs | |
| China 41 | Newborns with PPHN | 35.0 +/‐ 1.8 weeks 1900 +/‐ 300 g | 34.2 +/‐ 2.0 weeks 1800 +/‐ 200 g | nHFOV | MAP: 6 to 10 cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times the MAP | nIPPV | PIP: 15 to 20 cm H2O PEEP: 4 to 6 cm H2O Rate: 25 to 50 bpm | Not reported | |
| China 43 | < 36 weeks | 32.82 ± 1.87 weeks/ 2088.86 ± 583.37 g | 32.57 ± 2.69 weeks/ 2125.24 ± 781.48 g | nHFOV with non‐invasive surfactant | MAP: 6 to 12 cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times the MAP | Duo positive airway pressure (DuoPAP; Bilevel positive airway pressure) with non‐invasive surfactant (considered to be equivalent to nIPPV) | PIP: 12 to 15 cm H2O PEEP: 5 cm H2O Rate: 30 to 40 bpm | Not reported | |
| Turkey 37 | < 32 weeks | Median 29 (range 27 to 34) weeks Median 1250 (range 800 to 2240) g | Median 28 (range 26 to 32) weeks Median 1190 (range 600 to 2010) g | nHFOV | Ventilator: Babylog 8000 MAP: 6 cm H2O Frequency: 10 Hz Amplitude: deltaP 100% | HFNC | Ventilator: Precision Flow, Vapotherm (5 L/min) | Short binasal prongs | |
| BiPAP: bilevel positive airway pressure; BP‐CPAP: bi‐level pressure continuous positive airway pressure; bpm: beats per minute; CNO: MedicinCNO device manufacturer; DuoPAP: Duo positive airway pressure; GA: gestational age; InSurE: Intubate, Surfactant, Extubate; IQR: interquartile range; IT: Inspiratory time; MAP: mean airway pressure; MV: mechanical ventilation; HFNC: Heated humidified high‐flow nasal cannula; nCPAP: nasal continuous positive airway pressure; nHFOV: non‐invasive high‐frequency oscillatory ventilation; nHFPV: non‐invasive high‐frequency percussive ventilation; nIPPV: non‐invasive intermittent positive‐pressure ventilation; NR: not reported; NS: not stated; PEEP: positive end‐expiratory pressure; PIP: positive inspiratory pressure; PPHN: Persistent pulmonary hypertension of the newborn; RDS: respiratory distress syndrome. *4‐arm trial (nHFOV versus NIPPV versus nCPAP versus HFNC) | |||||||||
| Study | Country total participants | Eligibility criteria | Gestational age weeks/birthweight g | Intervention group | Control group | Interface (in both intervention and control groups) | |||
| Intervention group | Control group | Mode | Settings | Mode | Settings | ||||
| China 65 | Ventilated infants with respiratory distress | 32.5 ± 1.3 weeks 1790 ± 350 g | 32.4 ± 1.4 weeks 1850 ± 410 g | nHFOV | Ventilator: SLE baby 5000, Germany MAP: 5 to 7 cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times MAP | nCPAP | Ventilator: Stephan, Germany PEEP: 4 to 6 cm H2O | Short binasal prongs | |
| China 81 | Ventilated infants 28 to 34 weeks | 31.7 ± 1.7 weeks 1670 ± 353 g | 32.0 ± 1.9 weeks 1735 ± 327 g | nHFOV | Ventilator: CNO driver MAP: 6 cm H2O Frequency: 10 Hz Amplitude: visible chest oscillation | nCPAP | Ventilator: Bubble CPAP system PEEP: 6 cm H2O | Short binasal prongs | |
| China 206 | Ventilated infants < 37 weeks | 32.4 +/‐ 2.4 weeks 1859 +/‐ 569 g | 32.8 +/‐ 2.4 weeks 1917 +/‐ 478 g | nHFOV | Ventilator: SLE5000 MAP: 10 cm H2O Frequency: 10 Hz Amplitude: 35 cm H2O | nCPAP | Ventilator: Bubble CPAP system PEEP: 6 to 8 cm H2O | Short binasal prongs | |
| Germany 6 | Ventilated infants < 32 weeks < 1500 g | 25 (range 23 + 4/7 to 26 + 3/7) weeks 503 (420 to 568) g | 24 (range 23 + 6/7 to 24 + 6/7) weeks 668 (550 to 786) g | nHFOV | Ventilator: SLE5000 MAP: 8 cm H2O Frequency: 9 to 10 Hz Amplitude: 20 to 30 cm H2O | nCPAP | Ventilator: SLE 5000 PEEP: 8 cm H2O | Short binasal prongs | |
| China 114 | Ventilated infants 26 to 31 + 6/7 weeks < 1500 g | 30.6 +/‐ 1.3 weeks 1257 +/‐ 340 g | 30.8 +/‐ 1.4 weeks 1282 +/‐ 354 g | nHFOV | Ventilator: SLE5000 MAP: 8 to 14 cm H2O Frequency: 8 to 12 Hz Amplitude: 20 to 35 cm H2O | nCPAP | PEEP: 6 to 8 cm H2O | Binasal prongs | |
| China 80 | Ventilated infants with RDS | 3330 ± 240 g (range 2500 to 4200) g | 3410 ± 180 g (range 2600 to 4600) g | nHFOV | MAP: 2 to 4 cm H2O higher than MAP prior to extubation Frequency: 6 to 12 Hz Amplitude: 2.5 to 3 times the value for MAP | nCPAP | PEEP: 4 to 6 cm H2O | Not reported | |
| China 98 | Ventilated infants 25 to 33 + 6/7 weeks < 1500 g | 29.0 +/‐ 1.9 weeks 1118 +/‐ 202 g | 29.0 +/‐ 1.7 weeks 1132 +/‐ 203 g | nHFOV | Ventilator: Fabian HFO MAP: 10 cm H2O Frequency: 10 [6 to 12] Hz Amplitude: 25 [25 to 50] cm H2O | nCPAP | Ventilator: Fabian PEEP: 5 [3 to 8] cm H2O | Short binasal prongs | |
| China 68 | Ventilated preterm infants | 28.42 +/‐ 1.15 weeks | 28.36 +/‐ 1.24 weeks | nHFOV | MAP: Range 8 to 14 cm H2O Frequency: 8 to 12 Hz Amplitude: 20 to 35 cm H2O | nCPAP | PEEP: 6 to 8 cm H2O | Not reported | |
| China 240 | Ventilated infants < 37 weeks | 31.02 ± 1.88 weeks 1440 ± 300 g | 30.31 ± 1.58 weeks 1390 ± 320 g | nHFOV | Ventilator: Löwenstein Leoni plus MAP: 8 [6 to 12] cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times MAP with visible chest oscillation | nCPAP | Ventilator: F.STEPHAN PEEP: 4 to 6 cm H2O | Not reported | |
| China 70 | Ventilated infants 32 to 36 weeks | 33.8 +/‐ 0.8 weeks 1985 +/‐ 246 g | 33.6 +/‐ 1.1 weeks 1878 +/‐ 325 g | nHFOV | Ventilator: SLE5000 MAP: range 8 to 14 cm H2O Frequency: 8 to 12 Hz Amplitude: 20 to 35 cm H2O | nCPAP | Ventilator: NV8 PEEP: 3 to 8 cm H2O | Not reported | |
| China 998 | Ventilated infants 25 to 32 + 6/7 weeks | 29.4 +/‐ 1.8 weeks 1334 +/‐ 366 g | 29.5 +/‐ 1.7 weeks 1341 +/‐ 318 g | nHFOV | Ventilator: Piston/membrane oscillator MAP: 5 to 16 cm H2O Frequency: 8 to 10 Hz Amplitude: titrated to PaCO2 | nCPAP | Ventilator: PEEP: 5 to 8 cm H2O | Short binasal prongs | |
| Ukraine 24 | Ventilated infants ≤ 32 weeks ≤ 1500 g | 27.75 +/‐ 2.41 weeks 918 +/‐ 227 g | 27.66 +/‐ 1.66 weeks 1034 +/‐ 177 g | nHFOV | Ventilator: CNO driver MAP: 6 to 8 cm H2O Frequency: 10 Hz Amplitude: visible chest oscillation | nIPPV | Ventilator: Servo‐I PIP: 6 to 12 cm H2O PEEP: 4 to 8 cm H2O Rate: 15 to 25 bpm | Long or short binasal prongs or mask | |
| China 42 | Ventilated infants with RDS | 30.86 +/‐ 3.01 weeks | 31.02 +/‐ 3.23 weeks | nHFOV | MAP: < 14 cm H2O Amplitude: Amplitude set at visible oscillation noted at neck and chest area | nIPPV | PIP: 15 to 20 cm H2O PEEP: 4 to 6 cm H20 Rate: 40 bpm | Not reported | |
| China 98 | Ventilated infants 25 to 33 + 6/7 weeks < 1500 g | 29.0 +/‐ 1.9 weeks 1118 +/‐ 202 g | 28.9 +/‐ 2.0 weeks 1088 +/‐ 154 g | nHFOV | Ventilator: Fabian HFO MAP: 10 cm H2O Frequency: 10 [6 to 12] Hz Amplitude: 25 [25 to 50] cm H2O | nIPPV | Ventilator: Comen NV8 PIP: 15 [15 to 25] cm H2O PEEP: 4 [4 to 8] cm H2O Rate: 30 [15 to 40] bpm | Short binasal prongs | |
| India 42 | Ventilated infants 26 to 36 + 6/7 weeks | Median 32 (IQR 28 to 35) weeks Median 1500 (1120 to 2140) g | Median 31 (IQR 29 to 35) weeks Median 1495 (980 to 2214) g | nHFOV | Ventilator: SLE6000 MAP: 8 to 10 cm H2O Frequency: 10 to 12 Hz Amplitude: 25 to 35 cm H2O with visible chest oscillation | nIPPV | Ventilator: Dragger Babylog 8000 PIP: 2 cm H2O above pre‐extubation PIP PEEP: 4 to 6 cm H2O Rate: 40 to 50 bpm | Short binasal prongs or masks | |
| China 240 | Ventilated infants < 37 weeks | 31.02 ± 1.88 weeks 1440 ± 300 g | 30.82 ± 1.60 weeks 1430 ± 330 g | nHFOV | Ventilator: Löwenstein Leoni plus MAP: 8 [6 to 12] cm H2O Frequency: 6 to 12 Hz Amplitude: 2 to 3 times MAP with visible chest oscillation | nIPPV | nIPPV Ventilator: COMEN NV8 PIP: 10 cm H2O PEEP: 5 to 6 cm H2O Rate: 25 to 30 bpm | Not reported | |
| China 992 | Ventilated infants 25 to 32 + 6/7 weeks | nHFOV | Ventilator: Piston/membrane oscillator MAP: 5 to 16 cm H2O Frequency: 8 to 10 Hz Amplitude: titrated to PaCO2 | nIPPV | nIPPV Ventilator: any neonatal ventilator PIP: 10 to 25 cm H2O PEEP: 5 to 8 cm H2O Rate: 30 to 40 bpm | Short binasal prongs | |||
| CNO: MedicinCNO device manufacturer; IQR: interquartile range; MAP: mean airway pressure; MV: mechanical ventilation; nCPAP: nasal continuous positive airway pressure; nHFOV: non‐invasive high‐frequency oscillatory ventilation; nIPPV: non‐invasive intermittent positive‐pressure ventilation; NR: not reported; PaCO2: arterial partial pressure of carbon dioxide; PEEP: positive end‐expiratory pressure; PIP: positive inspiratory pressure; RDS: respiratory distress syndrome *3‐arm trials (nHFOV versus NIPPV versus nCPAP) | |||||||||
| Study | Country total participants | Eligibility criteria | Gestational age weeks/birthweight g | Intervention group | Control group | Interface (in both intervention and control groups) | |||
| Intervention group | Control group | Mode | Settings | Mode | Settings | ||||
| Canada 26 | Birthweight < 1250 g Current weight < 2000 g Failed nCPAP | 26.1 +/‐ 1.3 weeks gestation Birthweight 832 +/‐ 150 g PMA 28.6 +/‐ 1.5 weeks | 26.5 +/‐ 1.6 weeks gestation Birthweight 878 +/‐ 198 g PMA 29.0 +/‐ 2.3 weeks | nHFOV | Ventilator: Drager VN500, Lubeck, Germany MAP: 8 to 10 cm H2O Frequency: 5 to 14 Hz Amplitude: visible chest oscillation | BP‐CPAP (considered to be equivalent to nIPPV) | Ventilator: Infant‐Flow device PIP: 8 [7 to 10] cm H2O PEEP: 5 [7 to 10] cm H2O Rate: 20 to 30 bpm | Short binasal prongs or masks | |
| bpm: breaths per minute; BP‐CPAP: bi‐level pressure continuous positive airway pressure; MAP: mean airway pressure; nCPAP: nasal continuous positive airway pressure; nHFOV: non‐invasive high‐frequency oscillatory ventilation; niPPV: nasal intermittent positive‐pressure ventilation; PEEP: positive end‐expiratory pressure; PIP: positive inspiratory pressure; PMA: postmenstrual age | |||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Mortality before hospital discharge Show forest plot | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.20, 2.18] |
| 1.2 Duration of respiratory support, days Show forest plot | 1 | 80 | Mean Difference (IV, Fixed, 95% CI) | ‐0.43 [‐0.59, ‐0.27] |
| 1.3 Chronic lung disease at 36 weeks Show forest plot | 2 | 180 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.09, 1.59] |
| 1.4 Pulmonary air leak syndromes Show forest plot | 2 | 180 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.25 [0.05, 1.14] |
| 1.5 Length of hospital stay, days Show forest plot | 1 | 80 | Mean Difference (IV, Fixed, 95% CI) | ‐6.68 [‐8.08, ‐5.28] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Mortality before hospital discharge Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1.1 nHFV versus nCPAP | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.41, 2.41] |
| 2.1.2 nHFV versus nIPPV | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.86 [0.90, 3.83] |
| 2.1.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.2 Endotracheal intubation Show forest plot | 9 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.2.1 nHFV versus nCPAP | 5 | 571 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.33, 0.82] |
| 2.2.2 nHFV versus nIPPV | 5 | 228 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.76, 2.34] |
| 2.2.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.94 [0.65, 13.27] |
| 2.3 Trauma to the nostrils and upper airway Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.3.1 nHFV versus nCPAP | 2 | 161 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.72, 1.47] |
| 2.3.2 nHFV versus nIPPV | 2 | 118 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.68, 1.40] |
| 2.3.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.35 [1.25, 4.45] |
| 2.4 Failure of respiratory support Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.4.1 nHFV versus nCPAP | 3 | 463 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.36, 0.90] |
| 2.4.2 nHFV versus nIPPV | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.79 [0.62, 12.57] |
| 2.4.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.94 [0.65, 13.27] |
| 2.5 Duration of respiratory support, days Show forest plot | 10 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.5.1 nHFV vs nCPAP | 6 | 707 | Mean Difference (IV, Fixed, 95% CI) | ‐0.48 [‐0.55, ‐0.40] |
| 2.5.2 nHFV versus nIPPV | 5 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.22 [‐0.58, 1.01] |
| 2.5.3 nHFV versus HFNC | 1 | 37 | Mean Difference (IV, Fixed, 95% CI) | ‐6.40 [‐14.74, 1.94] |
| 2.6 Duration of oxygen therapy, days Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.6.1 nHFV versus nCPAP | 3 | 466 | Mean Difference (IV, Fixed, 95% CI) | 0.03 [‐0.05, 0.11] |
| 2.6.2 nHFV versus nIPPV | 3 | 185 | Mean Difference (IV, Fixed, 95% CI) | ‐0.65 [‐1.13, ‐0.17] |
| 2.7 Chronic lung disease at 36 weeks Show forest plot | 8 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.7.1 nHFV versus nCPAP | 4 | 481 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.35 [0.80, 2.27] |
| 2.7.2 nHFV versus nIPPV | 5 | 307 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.42, 0.95] |
| 2.7.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.46, 2.98] |
| 2.8 Death or chronic lung disease at 36 weeks Show forest plot | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 2.8.1 nHFV versus nCPAP | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 2.9 Patent ductus arteriosus Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.9.1 nHFV versus nCPAP | 2 | 105 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.29, 1.62] |
| 2.9.2 nHFV versus nIPPV | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.19, 2.40] |
| 2.9.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.27, 5.09] |
| 2.10 Pulmonary air leak syndromes Show forest plot | 10 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.10.1 nHFV versus nCPAP | 6 | 645 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.01 [0.70, 5.75] |
| 2.10.2 nHFV versus nIPPV | 5 | 267 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.27, 1.66] |
| 2.10.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.50 [0.15, 80.71] |
| 2.11 Proven sepsis Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.11.1 nHFV versus nCPAP | 2 | 77 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.38, 2.04] |
| 2.11.2 nHFV versus nIPPV | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.34, 1.66] |
| 2.11.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.42, 2.43] |
| 2.12 Necrotising enterocolitis Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.12.1 nHFV versus nCPAP | 3 | 407 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [0.52, 2.69] |
| 2.12.2 nHFV versus nIPPV | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.09, 4.64] |
| 2.12.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.23 [0.01, 4.55] |
| 2.13 Necrotising enterocolitis (NEC) (Bell stage ≥ 2) Show forest plot | 1 | 43 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.13.1 nHFV versus nIPPV | 1 | 43 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.14 Spontaneous intestinal perforation Show forest plot | 1 | 48 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.14.1 nHFV versus nIPPV | 1 | 48 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.15 Intraventricular haemorrhage, any Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.15.1 nHFV versus nCPAP | 3 | 179 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.16, 1.13] |
| 2.15.2 nHFV versus nIPPV | 5 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.30, 1.22] |
| 2.15.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.23 [0.01, 4.55] |
| 2.16 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.16.1 nHFV versus nCPAP | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.36, 3.78] |
| 2.16.2 nHFV versus nIPPV | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.16.3 nHFV versus HFNC | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.17 Periventricular leukomalacia Show forest plot | 1 | 43 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.44, 2.07] |
| 2.17.1 nHFV versus nIPPV | 1 | 43 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.44, 2.07] |
| 2.18 Retinopathy of prematurity, any Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.18.1 nHFV versus nCPAP | 1 | 74 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.12, 3.97] |
| 2.18.2 nHFV versus nIPPV | 2 | 168 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.30, 0.98] |
| 2.19 Retinopathy of prematurity, stage ≥ 3 Show forest plot | 1 | 302 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.29, 2.01] |
| 2.19.1 nHFV versus nCPAP | 1 | 302 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.77 [0.29, 2.01] |
| 2.20 Length of hospital stay, days Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.20.1 nHFV versus nCPAP | 4 | 602 | Mean Difference (IV, Fixed, 95% CI) | ‐4.07 [‐4.46, ‐3.67] |
| 2.20.2 nHFV versus nIPPV | 2 | 125 | Mean Difference (IV, Fixed, 95% CI) | ‐4.34 [‐6.22, ‐2.47] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Mortality before hospital discharge Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.1.1 nHFV versus nCPAP ‐ preterm infants | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.41, 2.41] |
| 3.1.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.41, 2.41] |
| 3.1.3 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 105 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.39 [0.02, 8.97] |
| 3.1.4 nHFV versus nCPAP ‐ nHFV Hz < 10 | 1 | 124 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.17, 3.11] |
| 3.2 Endotracheal intubation Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.2.1 nHFV versus nCPAP ‐ term or near‐term infants | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 3.2.2 nHFV versus nCPAP ‐ preterm infants | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.33, 0.82] |
| 3.2.3 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 5 | 571 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.33, 0.82] |
| 3.2.4 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 105 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.21, 1.18] |
| 3.2.5 nHFV versus nCPAP ‐ nHFV Hz < 10 | 2 | 164 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.43 [0.14, 1.32] |
| 3.3 Failure of respiratory support Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.3.1 nHFV versus nCPAP ‐ preterm infants | 3 | 463 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.36, 0.90] |
| 3.3.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 3 | 463 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.36, 0.90] |
| 3.3.3 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 1 | 37 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.74 [0.30, 1.83] |
| 3.3.4 nHFV versus nCPAP ‐ nHFV Hz < 10 | 1 | 124 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.43 [0.14, 1.32] |
| 3.4 Chronic lung disease at 36 weeks Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.4.1 nHFV versus nCPAP ‐ preterm infants | 4 | 481 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.35 [0.80, 2.27] |
| 3.4.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 3 | 407 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.43 [0.84, 2.44] |
| 3.4.3 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 105 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.41 [0.91, 6.38] |
| 3.5 Death or chronic lung disease at 36 weeks Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.5.1 nHFV versus nCPAP ‐ preterm infants | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 3.5.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 3.5.3 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 3.6 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.6.1 nHFV versus nCPAP ‐ preterm infants | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.36, 3.78] |
| 3.6.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 4 | 531 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.36, 3.78] |
| 3.6.3 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 105 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 3.6.4 nHFV versus nCPAP ‐ nHFV Hz < 10 | 1 | 124 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.11, 3.73] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Mortality before hospital discharge Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.1.1 nHFV versus nIPPV ‐ preterm infants | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.86 [0.90, 3.83] |
| 4.1.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.86 [0.90, 3.83] |
| 4.1.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 4.2 Endotracheal intubation Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.2.1 nHFV versus nIPPV ‐ term or near‐term infants | 1 | 41 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.10 [0.01, 1.78] |
| 4.2.2 nHFV versus nIPPV‐ preterm infants | 4 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.58 [0.84, 3.00] |
| 4.2.3 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 3 | 125 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.29 [0.68, 2.44] |
| 4.2.4 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.79 [0.62, 12.57] |
| 4.3 Failure of respiratory support Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.3.1 nHFV versus nIPPV‐ preterm infants | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.79 [0.62, 12.57] |
| 4.3.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.79 [0.62, 12.57] |
| 4.3.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.79 [0.62, 12.57] |
| 4.4 Chronic lung disease at 36 weeks Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.4.1 nHFV versus nIPPV ‐ preterm infants | 5 | 307 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.63 [0.42, 0.95] |
| 4.4.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 2 | 84 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.79 [0.37, 1.66] |
| 4.4.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.35 [0.78, 14.44] |
| 4.5 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.5.1 nHFV versus nIPPV ‐ preterm infants | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 4.5.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 1 | 36 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 4.5.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 32 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Mortality before hospital discharge Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1.1 nHFV versus nCPAP | 2 | 370 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.48 [0.43, 5.14] |
| 5.2 Endotracheal intubation Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.2.1 nHFV versus nCPAP | 3 | 410 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.28, 0.89] |
| 5.3 Failure of respiratory support Show forest plot | 1 | 302 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.31, 1.03] |
| 5.3.1 nHFV versus nCPAP | 1 | 302 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.31, 1.03] |
| 5.4 Chronic lung disease at 36 weeks Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.4.1 nHFV versus nCPAP | 2 | 370 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.28 [0.70, 2.33] |
| 5.5 Death or chronic lung disease at 36 weeks Show forest plot | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 5.5.1 nHFV versus nCPAP | 1 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.50 [0.52, 12.01] |
| 5.6 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 2 | 370 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.97 [0.37, 10.61] |
| 5.6.1 nHFV versus nCPAP | 2 | 370 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.97 [0.37, 10.61] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Mortality before hospital discharge Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.1.1 nHFV versus nCPAP | 6 | 1427 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.52, 1.64] |
| 6.1.2 nHFV versus nIPPV | 2 | 984 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.83 [0.70, 4.79] |
| 6.2 Endotracheal reintubation Show forest plot | 14 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.2.1 nHFV versus nCPAP | 11 | 1897 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.35, 0.51] |
| 6.2.2 nHFV versus nIPPV | 6 | 1364 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.54, 0.89] |
| 6.3 Trauma to the nostrils and upper airway Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.3.1 nHFV versus nCPAP | 4 | 1418 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.64, 1.44] |
| 6.3.2 nHFV versus nIPPV | 4 | 1254 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.66, 1.53] |
| 6.4 Failure of extubation Show forest plot | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 6.4.1 nHFV versus nCPAP | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 6.5 Duration of respiratory support, days Show forest plot | 7 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 6.5.1 nHFV versus nCPAP | 7 | 1371 | Mean Difference (IV, Fixed, 95% CI) | ‐0.11 [‐0.20, ‐0.03] |
| 6.5.2 nHFV versus nIPPV | 2 | 1052 | Mean Difference (IV, Fixed, 95% CI) | ‐2.09 [‐3.32, ‐0.85] |
| 6.6 Duration of oxygen therapy, days Show forest plot | 4 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 6.6.1 nHFV versus nCPAP | 4 | 1218 | Mean Difference (IV, Fixed, 95% CI) | ‐2.38 [‐3.48, ‐1.28] |
| 6.6.2 nHFV versus nIPPV | 3 | 1212 | Mean Difference (IV, Fixed, 95% CI) | ‐0.57 [‐1.59, 0.45] |
| 6.7 Chronic lung disease at 36 weeks Show forest plot | 11 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.7.1 nHFV versus nCPAP | 10 | 1829 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.67, 0.91] |
| 6.7.2 nHFV versus nIPPV | 4 | 1236 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.75, 1.04] |
| 6.8 Death or chronic lung disease at 36 weeks Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.8.1 nHFV versus nCPAP | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.77, 1.06] |
| 6.8.2 nHFV versus nIPPV | 3 | 1070 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.79, 1.08] |
| 6.9 Patent ductus arteriosus Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.9.1 nHFV versus nCPAP | 3 | 1258 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.84, 1.16] |
| 6.9.2 nHFV versus nIPPV | 3 | 1076 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.74, 1.05] |
| 6.10 Pulmonary air leak syndromes Show forest plot | 10 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.10.1 nHFV versus nCPAP | 8 | 1673 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.31, 1.15] |
| 6.10.2 nHFV versus nIPPV | 5 | 1322 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.36, 1.91] |
| 6.11 Proven sepsis Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.11.1 nHFV versus nCPAP | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.38, 1.87] |
| 6.11.2 nHFV versus nIPPV | 2 | 984 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.50, 2.00] |
| 6.12 Necrotising enterocolitis Show forest plot | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.12.1 nHFV versus nCPAP | 4 | 523 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.47, 1.45] |
| 6.12.2 nHFV versus nIPPV | 4 | 318 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.32, 3.24] |
| 6.13 Necrotising enterocolitis, Bell stage ≥ 2 Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.13.1 nHFV versus nCPAP | 3 | 1142 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.32 [0.82, 2.10] |
| 6.13.2 nHFV versus nIPPV | 2 | 984 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.58, 1.44] |
| 6.14 Intraventricular haemorrhage, any Show forest plot | 8 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.14.1 nHFV versus nCPAP | 7 | 1644 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.69, 1.21] |
| 6.14.2 nHFV versus nIPPV | 4 | 1236 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.73, 1.34] |
| 6.15 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.15.1 nHFV versus nCPAP | 3 | 1117 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.57, 1.13] |
| 6.15.2 nHFV versus nIPPV | 4 | 1162 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.55, 1.10] |
| 6.16 Periventricular leukomalacia Show forest plot | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.00 [0.40, 122.44] |
| 6.16.1 nHFV versus nIPPV | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 7.00 [0.40, 122.44] |
| 6.17 Retinopathy of prematurity, any Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.17.1 nHFV versus nCPAP | 4 | 1418 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.76 [0.58, 0.99] |
| 6.17.2 nHFV versus nIPPV | 4 | 1236 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.64, 1.13] |
| 6.18 Retinopathy of prematurity, stage ≥ 3 Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.18.1 nHFV versus nCPAP | 2 | 1052 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.61, 1.08] |
| 6.18.2 nHFV versus nIPPV | 2 | 1052 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.86 [0.64, 1.15] |
| 6.19 Length of hospital stay, days Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 6.19.1 nHFV versus nCPAP | 5 | 640 | Mean Difference (IV, Fixed, 95% CI) | ‐1.14 [‐2.01, ‐0.27] |
| 6.19.2 nHFV versus nIPPV | 3 | 276 | Mean Difference (IV, Fixed, 95% CI) | ‐1.05 [‐3.34, 1.24] |
| 6.20 Neurodevelopmental disability at least 18 months' postnatal age or later Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.20.1 nHFV versus nCPAP | 1 | 74 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.37, 2.29] |
| 6.20.2 nHFV versus nIPPV | 1 | 72 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.35, 2.16] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Mortality before hospital discharge Show forest plot | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.1.1 nHFV versus nCPAP ‐ preterm infants | 6 | 1427 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.52, 1.64] |
| 7.1.2 nHFV versus nCPAP ‐ nHFV MAP ≥ 10 cm H2O | 1 | 206 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.19, 2.29] |
| 7.1.3 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 3 | 147 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.15, 2.40] |
| 7.1.4 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 282 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.25, 1.85] |
| 7.1.5 nHFV versus nCPAP ‐ nHFV Hz < 10 | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.60 [0.53, 4.86] |
| 7.2 Endotracheal reintubation Show forest plot | 11 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.2.1 nHFV versus nCPAP ‐ term or near‐term infants | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.31 [0.13, 0.77] |
| 7.2.2 nHFV versus nCPAP ‐ preterm infants | 10 | 1817 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.42 [0.35, 0.52] |
| 7.2.3 nHFV versus nCPAP ‐ nHFV MAP ≥ 10 cm H2O | 2 | 298 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.21, 0.53] |
| 7.2.4 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 3 | 147 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.41 [0.25, 0.67] |
| 7.2.5 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 282 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.45 [0.30, 0.67] |
| 7.2.6 nHFV versus nCPAP ‐ nHFV Hz < 10 | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.39, 0.67] |
| 7.3 Failure of extubation Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.3.1 nHFV versus nCPAP ‐ preterm infants | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 7.3.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 7.3.3 nHFV versus nCPAP ‐ nHFV Hz < 10 | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 7.4 Chronic lung disease at 36 weeks Show forest plot | 10 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.4.1 nHFV versus nCPAP ‐ term or near‐term infants | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.05, 5.30] |
| 7.4.2 nHFV versus nCPAP ‐ preterm infants | 9 | 1749 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.67, 0.91] |
| 7.4.3 nHFV versus nCPAP ‐ nHFV MAP ≥ 10 cm H2O | 2 | 298 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.47 [0.29, 0.77] |
| 7.4.4 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 3 | 147 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.22, 1.90] |
| 7.4.5 nHFV versus nCPAP ‐ nHFV Hz ≥ 10 | 2 | 282 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.21, 1.46] |
| 7.4.6 nHFV versus nCPAP ‐ nHFV Hz < 10 | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.75, 1.04] |
| 7.5 Death or chronic lung disease at 36 weeks Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.5.1 nHFV versus nCPAP ‐ preterm infants | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.77, 1.06] |
| 7.5.2 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.50 [0.06, 4.47] |
| 7.5.3 nHFV versus nCPAP ‐ nHFV Hz < 10 | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.77, 1.06] |
| 7.6 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.6.1 nHFV versus nCPAP ‐ preterm infants | 3 | 1117 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.57, 1.13] |
| 7.6.2 nHFV versus nCPAP ‐ nHFV MAP ≥ 10 cm H2O | 1 | 92 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.09 [0.20, 22.24] |
| 7.6.3 nHFV versus nCPAP ‐ nHFV MAP < 10 cm H2O | 1 | 65 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.82 [0.17, 19.13] |
| 7.6.4 nHFV versus nCPAP ‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.76 [0.54, 1.09] |
| 7.7 Neurodevelopmental disability at least 18 months' postnatal age or later Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 7.7.1 nHFV versus nCPAP ‐ preterm infants | 1 | 72 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.35, 2.16] |
| 7.7.2 nHFV versus nCPAP ‐ nHFV MAP ≥ 10 cm H2O | 1 | 72 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.35, 2.16] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Mortality before hospital discharge Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1.1 nHFV versus nIPPV ‐ preterm infants | 2 | 984 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.83 [0.70, 4.79] |
| 8.1.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.50 [0.30, 7.43] |
| 8.1.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.50 [0.30, 7.43] |
| 8.1.4 nHFV versus nIPPV‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.00 [0.61, 6.60] |
| 8.2 Endotracheal reintubation Show forest plot | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.2.2 nHFV versus nIPPV ‐ preterm infants | 6 | 1364 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.54, 0.89] |
| 8.2.3 nHFV versus nIPPV ‐ nHFV MAP ≥ 10 cm H2O | 2 | 134 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.27 [0.11, 0.68] |
| 8.2.4 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.47, 1.80] |
| 8.2.5 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.47, 1.80] |
| 8.2.6 nHFV versus nIPPV‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.55, 1.01] |
| 8.3 Chronic lung disease at 36 weeks Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.3.2 nHFV versus nIPPV ‐ preterm infants | 4 | 1236 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.75, 1.04] |
| 8.3.3 nHFV versus nIPPV ‐ nHFV MAP ≥ 10 cm H2O | 1 | 92 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.44, 1.45] |
| 8.3.4 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.39, 2.58] |
| 8.3.5 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.39, 2.58] |
| 8.3.6 nHFV versus nIPPV‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.76, 1.06] |
| 8.4 Death or chronic lung disease at 36 weeks Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.4.1 nHFV versus nIPPV ‐ preterm infants | 3 | 1070 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.79, 1.08] |
| 8.4.2 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.60, 1.52] |
| 8.4.3 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.60, 1.52] |
| 8.4.4 nHFV versus nIPPV‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.78, 1.08] |
| 8.5 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.5.2 nHFV versus nIPPV ‐ preterm infants | 4 | 1162 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.55, 1.10] |
| 8.5.3 nHFV versus nIPPV ‐ nHFV MAP ≥ 10 cm H2O | 1 | 92 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.70 [0.12, 3.97] |
| 8.5.4 nHFV versus nIPPV ‐ nHFV MAP < 10 cm H2O | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.08, 1.92] |
| 8.5.5 nHFV versus nIPPV ‐ nHFV Hz ≥ 10 | 2 | 110 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.08, 1.92] |
| 8.5.6 nHFV versus nIPPV‐ nHFV Hz < 10 | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.57, 1.17] |
| 8.6 Neurodevelopmental disability at least 18 months' postnatal age or later Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.6.1 nHFV versus nIPPV ‐ preterm infants | 1 | 72 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.35, 2.16] |
| 8.6.2 nHFV versus nIPPV ‐ nHFV MAP ≥ 10 cm H2O | 1 | 72 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.35, 2.16] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 9.1 Mortality before hospital discharge Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 9.1.1 nHFV versus nCPAP | 4 | 1248 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.49, 2.09] |
| 9.1.2 nHFV versus nIPPV | 1 | 960 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.00 [0.61, 6.60] |
| 9.2 Endotracheal reintubation Show forest plot | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 9.2.1 nHFV versus nCPAP | 5 | 1340 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.45 [0.36, 0.56] |
| 9.2.2 nHFV versus nIPPV | 3 | 1138 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.71 [0.54, 0.94] |
| 9.3 Failure of extubation Show forest plot | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 9.3.1 nHFV versus nCPAP | 1 | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.60 [0.22, 1.65] |
| 9.4 Chronic lung disease at 36 weeks Show forest plot | 5 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 9.4.1 nHFV versus nCPAP | 5 | 1340 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.70, 0.95] |
| 9.4.2 nHFV versus nIPPV | 2 | 1052 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.75, 1.04] |
| 9.5 Death or chronic lung disease at 36 weeks Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 9.5.1 nHFV versus nCPAP | 2 | 966 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.77, 1.06] |
| 9.5.2 nHFV versus nIPPV | 2 | 1046 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.78, 1.07] |
| 9.6 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 9.6.1 nHFV versus nCPAP | 2 | 1052 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.55, 1.11] |
| 9.6.2 nHFV versus nIPPV | 3 | 1138 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.56, 1.13] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 10.1 Mortality before hospital discharge Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.44 [0.10, 21.33] |
| 10.2 Endotracheal intubation Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.23 [0.51, 2.98] |
| 10.3 Failure of respiratory support Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.58 [0.29, 1.16] |
| 10.4 Duration of oxygen therapy, days Show forest plot | 1 | 39 | Mean Difference (IV, Fixed, 95% CI) | 24.00 [‐8.18, 56.18] |
| 10.5 Chronic lung disease at 36 weeks Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.70, 1.47] |
| 10.6 Pulmonary air leak syndromes Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 10.7 Necrotising enterocolitis Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.47 [0.02, 10.87] |
| 10.8 Spontaneous intestinal perforation Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 10.9 Intraventricular haemorrhage, Papile grade 3/4 Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.47 [0.02, 10.87] |
| 10.10 Periventricular leukomalacia Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 10.11 Retinopathy of prematurity, stage ≥ 3 Show forest plot | 1 | 39 | Risk Ratio (M‐H, Fixed, 95% CI) | 9.88 [0.55, 179.12] |
