Bi-Level Noninvasive Ventilation in Neonatal Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV premature infants with RDS. Nonsynchronized nasal intermittent positive pressure (nsNIPPV) synchronized NIPPV (SNIPPV) use settings ≥ those during mechanical (MV), biphasic continuous airway (BiPAP) two (NCPAP) levels ≤4 cm H<sub>2</sub>O apart. <b><i>Methods:</i></b> A systematic (Medline OVID Pubmed) meta-analysis of randomized controlled trials. Primary outcomes were bronchopulmonary dysplasia (BPD) mortality. Secondary included failure (intubation) extubation (re-intubation). Data pooled using a fixed-effects model calculate the relative risk (RR) 95% confidence interval (CI) between modes (RevMan v 5.3, Copenhagen, Denmark). <b><i>Results:</i></b> Twenty-four trials that largely did not correct for mean (MAP) outdated ventilators included. Compared NCPAP, both nsNIPPV SNIPPV resulted less re-intubation (RR 0.88 CI (0.80, 0.97) RR 0.20 (0.10, 0.38), respectively) BPD 0.69 (0.49, 0.51 (0.29, 0.88), respectively). also intubation 0.57 (0.45, 0.73) versus no difference One study showed BiPAP NCPAP. <b><i>Conclusions:</i></b> NCPAP may reduce MV Studies comparing equivalent MAP utilizing currently available machines are needed.