Requirement of mechanical ventilation
A total of 31 studies enrolling 3783 neonates with 669 events in the
network was analysed (Figure 2, Table 2). Inconsistency
assessed by node-splitting for all the outcomes is illustrated inE-Figure 3 and E-Figure 4 . In comparison with HFNC,
only NIPPV showed a statistically significant reduction in the
requirement of MV [0.66 (0.43, 0.99)](Figure 3) . Also,
NIPPV was more effective in decreasing the risk of MV intubation when
compared to CPAP [0.60 (0.44, 0.79)]. The league matrix is given inTable 3 . SUCRA for NIPPV, BiPAP, HFNC and CPAP were 0.94, 0.59,
0.32 and 0.13 respectively making NIPPV the best initial mode of NRS and
CPAP the least effective (Figure 4) . Meta-regression with
gestational age as covariate showed a trend of improving efficacy of
HFNC in reducing the risk for mechanical ventilation with increasing
gestational age when compared to NIPPV, BiPAP and CPAP (E-figure
5) . The pairwise comparison of different NRS interventions evaluating
the direct evidence for the primary outcomes is illustrated as forest
plots in Figure 5.