Zeng Juan, Tan Rong, Cao Haiyan
Department of Pediatrics, Southwest Hospital of Army Medical University, Chongqing, China.
Department of Neonatology, Jiulongpo People's Hospital, Chongqing, China.
Eur J Pediatr. 2025 Jun 28;184(7):455. doi: 10.1007/s00431-025-06282-7.
The aim of the present systematic review was to determine whether non-invasive intermittent positive pressure ventilation (NIPPV), as initial respiratory support for preterm infants with respiratory distress syndrome (RDS), reduces the incidence of invasive ventilation (IV) and bronchopulmonary dysplasia (BPD) more effectively than nasal continuous positive airway pressure (NCPAP). We systematically searched Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) for records published between 1980 and February 2022. RCTs comparing early NIPPV with NCPAP as initial respiratory support in preterm infants with RDS were included. Two reviewers independently extracted data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated using random-effects meta-analysis. Subgroup analyses were performed for infants receiving surfactant and stratified by gestational age (GA) or birth weight (BW). The primary outcomes were the incidence of IV and BPD. A total of 14 randomized clinical trials (RCTs) involving 1755 infants were included. Compared with NCPAP, early NIPPV significantly reduced the incidence of IV (risk ratio [RR], 0.53; 95% CI, 0.43-0.64; P < .001) and the incidence of BPD (RR, 0.48; 95% CI, 0.29-0.79; P = .004). The reduction in the incidence of IV remained statistically significant across multiple subgroups: GA > 30 weeks (RR, 0.41; 95% CI, 0.27-0.63; P < .001) and GA ≤ 30 weeks (RR, 0.31; 95% CI, 0.20-0.48; P < .001); infants treated with surfactant (RR, 0.60; 95% CI, 0.43-0.83; P = .002); BW ≤ 1500 g (RR, 0.54; 95% CI, 0.38-0.77; P < .001) and BW > 1500 g (RR, 0.53; 95% CI, 0.36-0.77; P = .001). However, the reduction in the incidence of BPD was significant only in subgroups stratified by GA: GA > 30 weeks (RR, 0.40; 95% CI, 0.18-0.90; P = .03) and GA ≤ 30 weeks (RR, 0.33; 95% CI, 0.14-0.75; P = .008).
Early NIPPV appears superior to NCPAP for reducing the incidence of IV and BPD in preterm infants with RDS. Nevertheless, higher-quality evidence is needed for definitive recommendations.
• Nasal intermittent positive pressure ventilation (NIPPV) delivers cyclical peak pressure support and may outperform nasal continuous positive airway pressure (NCPAP). While some randomized controlled trials (RCTs) show NIPPV reduces invasive ventilation rates compared to NCPAP, its effect on bronchopulmonary dysplasia (BPD) incidence remains inconclusive.
• NIPPV appears superior to NCPAP in reducing the incidence of IV and BPD in preterm infants with respiratory distress syndrome (RDS) as initial noninvasive respiratory support.
本系统评价的目的是确定无创间歇正压通气（NIPPV）作为呼吸窘迫综合征（RDS）早产儿的初始呼吸支持，与经鼻持续气道正压通气（NCPAP）相比，是否能更有效地降低有创通气（IV）和支气管肺发育不良（BPD）的发生率。我们系统检索了Medline、Embase、科学网和Cochrane对照试验中心注册库（CENTRAL），以获取1980年至2022年2月发表的记录。纳入了比较早期NIPPV与NCPAP作为RDS早产儿初始呼吸支持的随机对照试验（RCT）。两名评价者独立提取数据。采用随机效应荟萃分析计算合并相对风险（RRs）及95%置信区间（CI）。对接受表面活性剂治疗的婴儿进行亚组分析，并按胎龄（GA）或出生体重（BW）分层。主要结局是IV和BPD的发生率。共纳入14项涉及1755例婴儿的随机临床试验（RCT）。与NCPAP相比，早期NIPPV显著降低了IV的发生率（风险比[RR]，0.53；95%CI，0.43 - 0.64；P＜0.０01）和BPD的发生率（RR，0.48；95%CI，0.29 - 0.79；P = 0.004）。IV发生率的降低在多个亚组中仍具有统计学意义：GA＞30周（RR，0.41；95%CI，0.27 - 0.63；P＜0.０01）和GA≤30周（RR，0.31；95%CI，0.20 - 0.48；P＜0.０01）；接受表面活性剂治疗的婴儿（RR，0.60；95%CI，0.43 - 0.83；P = 0.002）；BW≤1500g（RR，0.54；95%CI，0.38 - 0.77；P＜0.０01）和BW＞1500g（RR，0.53；95%CI，0.36 - 0.77；P = 0.001）。然而，BPD发生率的降低仅在按GA分层的亚组中具有统计学意义：GA＞30周（RR，0.40；95%CI，0.18 - 0.90；P = 0.03）和GA≤30周（RR，0.33；95%CI，0.14 - 0.75；P = 0.008）。
早期NIPPV在降低RDS早产儿IV和BPD的发生率方面似乎优于NCPAP。然而，需要更高质量的证据来给出明确的推荐。
• 经鼻间歇正压通气（NIPPV）提供周期性峰值压力支持，可能优于经鼻持续气道正压通气（NCPAP）。虽然一些随机对照试验（RCT）表明，与NCPAP相比，NIPPV可降低有创通气率，但其对支气管肺发育不良（BPD）发生率的影响仍不确定。
• 作为初始无创呼吸支持，NIPPV在降低呼吸窘迫综合征（RDS）早产儿IV和BPD的发生率方面似乎优于NCPAP。
