Periodic Rotation versus Continuous Application of Same Nasal Interface for Non-invasive Respiratory Support in Preterm Neonates: A Systematic Review and Meta-analysis.

ABSTRACT

OBJECTIVES: To review whether the periodic rotation of nasal mask with binasal prongs is superior to continuous application of either of the interfaces in preterm infants on non-invasive positive pressure respiratory support. METHOD: The authors searched Medline, CINAHL, Embase, Web of Science, and CENTRAL for randomized controlled trials (RCTs) comparing periodic rotation of the two interfaces (mask or prongs) against the continuous application of either, in preterm infants on nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). They performed a random-effects meta-analysis using RevMan 5.4. The primary outcome was the incidence of moderate to severe nasal injury. Other outcomes included any nasal injury, need for invasive ventilation, duration of respiratory support, hospital stay, and mortality. RESULTS: Four RCTs (520 participants) were included. There was no difference in the incidence of moderate to severe nasal injury between periodic rotation vs. continuous nasal mask (3 RCTs, 293 participants; RR 1.75, 95% CI 0.73-4.19), or periodic rotation vs. continuous binasal prongs (3 RCTs, 296 participants; RR 0.40, 95% CI 0.14-1.11). Periodic rotation lowered the incidence of any grade nasal injury compared to continuous binasal prongs (RR 0.61, 95% CI 0.49-0.75) but not compared to continuous nasal mask (RR 1.38, 95% CI 0.92-2.06). Periodic rotation was associated with longer non-invasive respiratory support (compared to prongs) and prolonged hospital stay (compared to masks). There were no significant differences in other clinical outcomes. CONCLUSIONS: Among preterm infants receiving non-invasive respiratory support, periodically rotating a nasal mask with short binasal prongs may not be superior to the continuous application of nasal masks.