673 - Noninvasive neurally adjusted ventilatory assist in preterm infants with respiratory distress: a systematic review and meta-analysis

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 673
Publication Number: 673.443

Yohei Minamitani, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Naoyuki Miyahara, Saitama medical center, Kawagoe, Saitama, Japan; Masayo Kanai, Saitama medical center, Kawagoe, Saitama, Japan; Erika Ota, St.Luke's international university, Chuo-ku, Tokyo, Japan; Fumihiko Namba, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

Presenting Author(s)

Yohei Minamitani, MD (he/him/his)

Assistant Professor of Pediatrics
Saitama Medical Center, Saitama Medical University
Kawagoe, Saitama, Japan

Background: Noninvasive neurally adjusted ventilatory assist (NIV-NAVA) improves patient–ventilator synchrony and is suggested to prevent treatment failure and reduce intubation and mechanical ventilation in preterm infants compared with nasal continuous positive airway pressure (NCPAP) or noninvasive positive-pressure ventilation (NIPPV). However, the effects of NIV-NAVA in preterm infants remain unclear.

Objective: This study aimed to conduct a systematic review and meta-analysis to assess the effectiveness and safety of NIV-NAVA in preterm infants with respiratory distress.

Design/Methods: A systematic review was conducted according to standard methods from the Cochrane Handbook for Systematic Reviews of Interventions, and the protocol was registered in PROSPERO. The following electronic databases were searched; CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PubMed, and WHO ICTRP. Four reviewers independently assessed the eligibility of studies and extracted data for study quality and evidence synthesis assessment. The studies included were individual and cluster randomized controlled trials comparing the effects of NIV-NAVA versus other noninvasive ventilation modes in preterm infants < 37 weeks of gestation who require noninvasive respiratory support. The quality of evidence was evaluated using the GRADE approach.

Results: Four randomized controlled trials (a total of 259 preterm infants) were included. In a subgroup of secondary use after extubation, NIV-NAVA reduces the risk of treatment failure compared with NCPAP/NIPPV (risk ratio, 0.29; 95% confidence interval, 0.10–0.81; two trials, 96 infants, moderate certainty of evidence). No statistically significant differences in secondary outcomes, including bronchopulmonary dysplasia, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, and retinopathy of prematurity (low certainty of evidence), were noted. In a subgroup of primary use at birth, no statistical differences in treatment failure and other secondary outcomes between NIV-NAVA and NCPAP/NIPPV (very low certainty of evidence) were observed.

Conclusion(s):

This study suggested that NIV-NAVA may reduce the risk of treatment failure and prevent reintubation in preterm infants after extubation.