Article type
Year
Abstract
Background: Severe respiratory distress is one of the major causes of neonatal deaths. Continuous positive airway pressure (CPAP) is one of the modalities of respiratory support used in treatment of respiratory distress, however it is not readily available in many low- and middle-income countries.
Objectives: To evaluate the effects of CPAP compared with nasal oxygen in neonates with respiratory distress.
Methods: We conducted a systematic review for trials comparing the use of nasal oxygen to bubble CPAP or high flow nasal cannula in preterm and term neonates with respiratory distress. Outcomes were death, treatment failure, need for mechanical ventilation or transfer and adverse events; pneumothorax, nasal injury, retinopathy, neonatal sepsis. We combined dichotomous data using risk ratios (with 95% confidence intervals (CI) while continuous data were combined using mean differences (with 95% CIs). For a subset of studies where meta-analysis was performed we explored heterogeneity and appraised the quality of the available evidence using GRADE (Grading of Assessment, Development and Evaluation).
Results: We identified three randomized controlled trials. There is moderate certainty in evidence of effects that compared to nasal oxygen; CPAP probably reduces treatment failure (RR 0.63, 95% CI 0.52 to 0.78; three trials, 607 participants) and need for mechanical ventilation (RR 0.64, 95% CI 0.52 to 0.79; three trials, 607 participants) and may reduce the transfer rates to neonatal intensive care units (RR 0.51, 95% CI 0.31 to 0.85; one trial, 300 participants, low certainty in the evidence of effect). Although there may be no differences in rates of pneumothorax, neonatal sepsis, necrotising enterocolitis, intraventricular haemorrhages, bronchopulmonary dysplasia and retinopathy of prematurity among those on CPAP compared to nasal oxygen, CPAP may cause more nasal injuries among neonates (RR 10.5, 95% CI 1.38 to 80.1; two trials 556 participants, moderate certainty in the evidence of effect).
Conclusions: We conclude that nasal CPAP may improve outcomes of neonates with respiratory distress with minimal increase in the adverse events.
Objectives: To evaluate the effects of CPAP compared with nasal oxygen in neonates with respiratory distress.
Methods: We conducted a systematic review for trials comparing the use of nasal oxygen to bubble CPAP or high flow nasal cannula in preterm and term neonates with respiratory distress. Outcomes were death, treatment failure, need for mechanical ventilation or transfer and adverse events; pneumothorax, nasal injury, retinopathy, neonatal sepsis. We combined dichotomous data using risk ratios (with 95% confidence intervals (CI) while continuous data were combined using mean differences (with 95% CIs). For a subset of studies where meta-analysis was performed we explored heterogeneity and appraised the quality of the available evidence using GRADE (Grading of Assessment, Development and Evaluation).
Results: We identified three randomized controlled trials. There is moderate certainty in evidence of effects that compared to nasal oxygen; CPAP probably reduces treatment failure (RR 0.63, 95% CI 0.52 to 0.78; three trials, 607 participants) and need for mechanical ventilation (RR 0.64, 95% CI 0.52 to 0.79; three trials, 607 participants) and may reduce the transfer rates to neonatal intensive care units (RR 0.51, 95% CI 0.31 to 0.85; one trial, 300 participants, low certainty in the evidence of effect). Although there may be no differences in rates of pneumothorax, neonatal sepsis, necrotising enterocolitis, intraventricular haemorrhages, bronchopulmonary dysplasia and retinopathy of prematurity among those on CPAP compared to nasal oxygen, CPAP may cause more nasal injuries among neonates (RR 10.5, 95% CI 1.38 to 80.1; two trials 556 participants, moderate certainty in the evidence of effect).
Conclusions: We conclude that nasal CPAP may improve outcomes of neonates with respiratory distress with minimal increase in the adverse events.