Noninvasive neurally-adjusted ventilatory assist in preterm infants: a systematic review and meta-analysis.

Autor:	Minamitani Y; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan., Miyahara N; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan., Saito K; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan., Kanai M; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan., Namba F; Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan., Ota E; Graduate School of Nursing Sciences, Global Health Nursing, St Luke's International University, Tokyo, Japan.; The Tokyo Foundation for Policy Research,Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2024 Dec; Vol. 37 (1), pp. 2415373. Date of Electronic Publication: 2024 Oct 15.
DOI:	10.1080/14767058.2024.2415373
Abstrakt:	Background: Noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) improves patient-ventilator synchrony and may reduce treatment failure in preterm infants compared with nasal continuous positive airway pressure (NCPAP) and noninvasive positive-pressure ventilation (NIPPV). We conducted a systematic review and meta-analysis to assess the effects of NIV-NAVA in preterm infants with respiratory distress. Methods: Four investigators independently assessed the eligibility of studies in CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PubMed, and WHO ICTRP databases, and extracted data. The included studies were randomized controlled trials (RCTs) comparing NIV-NAVA with other noninvasive ventilation modalities in preterm infants. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The objective of the meta-analysis was to compare NIV-NAVA vs CPAP/NIPPV as a primary mode post extubation. Results: Five RCTs which examined 279 preterm infants were included. In the subgroup of post-extubation respiratory support, NIV-NAVA decreased treatment failure compared with NCPAP/NIPPV (risk ratio 0.29; 95% confidence interval [0.10, 0.81], 2 RCTs, 96 infants, low certainty of the evidence). NIV-NAVA did not significantly reduce the risk of treatment failure in the subgroup of primary respiratory support (very low certainty of the evidence). There were no significant differences in secondary outcomes with low to very low certainty of evidence. Conclusions: In a small cohort with low certainty of evidence, NIV-NAVA may prevent reintubation in preterm infants. Further large-scale RCTs are needed to determine the effects and safety of NIV-NAVA in preterm infants.
Databáze:	MEDLINE
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