Non-invasive high-frequency oscillatory ventilation (NHFOV) versus nasal continuous positive airway pressure (NCPAP) for preterm infants: a systematic review and meta-analysis

Arch Dis Child Fetal Neonatal Ed. 2024 Jun 19;109(4):397-404. doi: 10.1136/archdischild-2023-325681.

Abstract

Objective: To compare the efficacy and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants.

Design: The study conducted a comprehensive analysis across three databases, namely EMBASE, MEDLINE and Cochrane Central, to identify randomised controlled trials comparing NHFOV and NCPAP. Statistical analysis was performed using Review Manager V.5.3 software.

Main outcomes measures: The primary outcomes of the study were the intubation or reintubation rate in the NHFOV and NCPAP groups. Additionally, secondary outcomes included the partial pressure of carbon dioxide levels and major complications associated with non-invasive respiratory support ventilation.

Results: Ten randomised controlled studies, involving 2031 preterm infants, were included in this meta-analysis. When compared with NCPAP, NHFOV demonstrated a significant reduction in the intubation or reintubation rate (p<0.01, relative risk=0.45, 95% CI 0.37 to 0.55), and there was no statistical difference in related complications.

Conclusion: In preterm infants, NHFOV appears to be an effective intervention for decreasing the intubation or reintubation rate compared with NCPAP, with no increase in associated complications.

Trial registration number: CRD42023403968.

Keywords: intensive care units, neonatal; neonatology.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Comparative Study

MeSH terms

  • Continuous Positive Airway Pressure* / adverse effects
  • Continuous Positive Airway Pressure* / methods
  • High-Frequency Ventilation* / adverse effects
  • High-Frequency Ventilation* / methods
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Noninvasive Ventilation* / adverse effects
  • Noninvasive Ventilation* / methods
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome, Newborn* / therapy