Meta-Analysis of Prophylactic Post-Extubation Nasal Continuous Positive Airway Pressure (Ncpap) in Preterm Infants

Aim: To review the evidence whether prophylactic NCPAP reduces the need for additional ventilatory support in preterm infants postextubation.

Study Selection: All trials utilizing random or quasi-random patient allocation, in which NCPAP was compared with headbox oxygen. Quality of methodology assessed independently by the two authors. Methods: Systematic search in accordance with Cochrane reviews. Meta-analysis using event rate ratios (ERP) and event rate differences (ERD). Primary outcome was“failure” of extubation i.e., reaching predefined clinical criteria (apnoea, resp acidosis, O₂ requirements). Secondary outcomes were the need for endotracheal reintubation (3 trials allowed crossover between groups) and oxygen dependency at 28 days.

Results: 7 trials identified. NNT = number needed to treat.Table

Table 1

Conclusions: NCPAP is effective in preventing failure of extubation. A non-significant trend exists for a reduction of incidence of oxygen use at 28 days of life in the NCPAP group.