Outcomes of noninvasive neurally adjusted ventilatory assist and nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Introduction: The benefits of neurally adjusted ventilatory assist (NAVA) in preterm infants are unclear. This study aimed to explore if noninvasive NAVA ismorebeneficial for preterm infants than nasal continuous positive airway pressure (NCPAP). Study design: Meta-analysis was performed in three clinical trials comprising two randomized controlled trials and one crossover study. We compared NIV-NAVA and NC PAP and reported treatment failure, mortality, and adverse events as the primary outcomes. Results: Three studies including 173 patients (89 of whom underwent NIV-NAVA) were eligible for this meta-analysis. This review found no difference in treatment failure between NIV-NAVA and NCPAP (RR 1.09, 95% CI 0.65 to 1.84; RD 0.02, 95% CI -0.10-014; 12=33%, P=0.23). Similarly, there was no difference in mortality (RR 152, 95% CI 0.51-4.52, heterogeneity not applicable). Compared with NCPAP, NIVNAV A significantly reduced the use of caffeine (RR 0.85, 95% CI 0.74-0.98, I-2=71%, P=0.03). Conclusions: Compared with NCPAP, there is insufficient evidence to conclude on the benefits or harm of NIV-NAVA therapy for preterm infants. The findings of this review should he confirmed using methodologically rigorous and adequately powered clinical trials. Key words: noninvasive ventilation, premature infant, artificial respiration, interactive ventilatory, support, bronchopalmonary dysplasia.