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NIV-NAVA versus non-invasive respiratory support in preterm neonates: a meta-analysis of randomized controlled trials

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To analyze the clinical and physiological outcomes of NIV-NAVA in preterm infants compared with other non-invasive respiratory support.

Study design

We conducted a meta-analysis of RCTs and randomized crossover studies comparing NIV-NAVA to other non-invasive strategies in preterm neonates.

Results

NIV-NAVA was superior to other non-invasive support in maximum EAdi (MD − 0.66 µV; 95% CI − 1.17 to −0.15; p = 0.01), asynchrony index (MD − 49.8%; 95% CI − 63.1 to −36.5; p < 0.01), and peak inspiratory pressure (MD − 2.2 cmH2O; 95% CI − 2.7 to −1.7; p < 0.01). However, there were no significant differences in the incidences of intubation (RR 0.91; 95% CI 0.56–1.48; p = 0.71), reintubation (RR 0.72; 95% CI 0.45–1.16; p = 0.18), or bronchopulmonary dysplasia (RR 0.77; 95% CI 0.37–1.60; p = 0.48).

Conclusion

NIV-NAVA was associated with improvements in maximum Edi, asynchrony index, and peak inspiratory pressure relative to other non-invasive respiratory strategies, without significant differences in clinical outcomes between groups.

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Fig. 1: PRISMA flow diagram.
Fig. 2: Forest plot of clinical outcomes.
Fig. 3: Forest plot of physiological outcomes.
Fig. 4: Forest plot of subgroup analysis.
Fig. 5: Forest plot of subgroup analysis.

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Funding

This study was conducted without funding support.

Author information

Authors and Affiliations

  1. Federal University of Campina Grande Faculty of Medicine, Campina Grande, Brazil

    Milena R. Tomé

  2. Division of Neonatal Critical Care, University of São Paulo, Ribeirão Preto, Brazil

    Eduardo A. de S. Orlandin, Walusa A. Gonçalves-Ferri & Thaís Iwashita-Lages

  3. Joana de Gusmão Children’s Hospital, Florianópolis, Brazil

    Mariana T. Zinher

  4. Faculdade De Ciências Médicas de São josé dos Campos, São josé dos Campos, Brazil

    Sofia O. Dias

  5. Division of Paediatrics and Neonatal Critical Care, South “A.Beclere” Medical Center, Paris, France

    Daniele De Luca

Authors
  1. Milena R. Tomé
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Contributions

MRT formulated and structured the study, selected the included studies, collected data, performed the statistical analysis, drafted the preliminary manuscript, and critically reviewed and revised the manuscript. EASO selected the included studies, collected data, performed the statistical analysis, drafted the initial manuscript, and critically reviewed and revised the manuscript. MTZ and SOD carried out the initial analyses, and critically reviewed and revised the manuscript. DDL and WAG-F critically reviewed and revised the manuscript for important intellectual content. TIL formulated the study, coordinated and supervised data collection, drafted the initial manuscript and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Milena R. Tomé or Thaís Iwashita-Lages.

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Competing interests

DDL conflict of interest: AIRWAY THERAPEUTICS and CHIESI as advisory Committee, Consultant, Research Support including clinical trials & the principal or named investigator, Speaker Honorarium including speaker bureau, symposia, and expert witness. Remaining authors report no relationships that could be construed as conflicts of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Tomé, M.R., Orlandin, E.A.d.S., Zinher, M.T. et al. NIV-NAVA versus non-invasive respiratory support in preterm neonates: a meta-analysis of randomized controlled trials. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01947-x

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  • DOI: https://doi.org/10.1038/s41372-024-01947-x

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