Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA,
Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA.
Neonatology. 2019;116(2):100-114. doi: 10.1159/000496462. Epub 2019 Jun 4.
Nasal continuous positive airway pressure (NCPAP) is an effective method of respiratory support for preterm infants. Nasal masks and binasal prongs are two interfaces available to deliver NCPAP, and it is unclear if one is superior to the other. We conducted a systematic review and meta-analysis, using the methodology recommended by the Cochrane Collaboration, to compare the efficacy and safety of nasal masks versus binasal prongs to deliver NCPAP in preterm infants <37 weeks of gestation. Ovid MEDLINE, Embase, Scopus, the Cochrane database, and PubMed were searched in February 2019. Seven trials met the inclusion criteria. Among preterm infants requiring NCPAP, the use of a nasal mask, compared to nasal prongs, decreased the rate of NCPAP failure within 72 h (RR 0.72, 95% CI 0.53-0.97; number needed to treat for an additional beneficial outcome [NNTB] 12.5, 95% CI 7.1-100; 5 trials, 576 participants; low-certainty evidence) and the incidence of nasal injury (RR 0.71, 95% CI 0.59-0.85; NNTB 8.3, 95% CI 5.6-16.7; 6 trials, 665 participants; low-certainty evidence). In a subgroup of preterm infants requiring NCPAP after resuscitation at birth, the use of a nasal mask decreased the incidence of moderate-to-severe bronchopulmonary dysplasia (RR 0.47, 95% CI 0.23-0.95; NNTB 16.7, 95% CI 9.1-100; 4 trials, 395 participants; very-low-certainty evidence) and the need for subsequent surfactant administration (RR 0.78, 95% CI 0.64-0.96; NNTB 8.33, 95% CI 4.54-33.33; 4 trials, 395 participants; low-certainty evidence). The use of nasal masks for preterm infants requiring NCPAP was associated with a reduction in NCPAP failure, need for surfactant administration, and moderate-to-severe bronchopulmonary dysplasia (low- to very-low-certainty evidence). Given the potential clinical benefit and minimal risk associated with a change in patient interface, nasal masks should be considered the preferred interface for NCPAP delivery in preterm infants.
经鼻持续气道正压通气（NCPAP）是早产儿呼吸支持的有效方法。鼻罩和双鼻插管是提供 NCPAP 的两种接口，目前尚不清楚哪种方法更优。我们采用 Cochrane 协作推荐的方法进行了系统评价和荟萃分析，比较了经鼻罩与双鼻插管在 <37 孕周早产儿中应用 NCPAP 的疗效和安全性。2019 年 2 月，检索了 Ovid MEDLINE、Embase、Scopus、Cochrane 数据库和 PubMed。7 项试验符合纳入标准。在需要 NCPAP 的早产儿中，与鼻插管相比，使用鼻罩可降低 72 小时内 NCPAP 失败率（RR 0.72，95%CI 0.53-0.97；额外获益需要治疗的人数[NNTB]为 12.5，95%CI 7.1-100；5 项试验，576 名参与者；低质量证据）和鼻损伤发生率（RR 0.71，95%CI 0.59-0.85；NNTB 8.3，95%CI 5.6-16.7；6 项试验，665 名参与者；低质量证据）。在出生后复苏时需要 NCPAP 的早产儿亚组中，使用鼻罩可降低中重度支气管肺发育不良发生率（RR 0.47，95%CI 0.23-0.95；NNTB 16.7，95%CI 9.1-100；4 项试验，395 名参与者；极低质量证据）和随后需要表面活性剂治疗的发生率（RR 0.78，95%CI 0.64-0.96；NNTB 8.33，95%CI 4.54-33.33；4 项试验，395 名参与者；低质量证据）。对于需要 NCPAP 的早产儿，使用鼻罩与降低 NCPAP 失败率、需要表面活性剂治疗和中重度支气管肺发育不良发生率相关（低至极低质量证据）。鉴于改变患者接口可能带来的潜在临床获益和最小风险，鼻罩应被视为早产儿 NCPAP 输送的首选接口。
