INTRODUCTION
The introduction of surfactant had a major impact in improving the
outcomes of preterm neonates with RDS1.There was a
major shift in the practice of surfactant therapy in the last decade
with studies showing better outcomes with early selective rescue
treatment when compared to the previously practiced prophylactic
administration2. Stabilising neonates with RDS on a
non-invasive respiratory support (NRS) such as CPAP and then instituting
surfactant therapy in selective neonates who have an increased oxygen
requirement has become the standard practice3. Newer
modalities of NRS strategies that have come into practice in neonatal
medicine in the past two decades, include heated and humidified high
flow cannula (HFNC), non-invasive positive pressure ventilation (NIPPV),
bilevel CPAP (BiPAP) as well as nasal high frequency oscillation
ventilation (nHFOV)4,5.
Several systematic reviews compared different NRS strategies in
pair-wise meta-analysis, however only one network meta-analysis (NMA)
evaluated different NRS strategies in preterm neonates with
RDS6-10. The NMA by Isamaya et al. also included
different modalities of surfactant instillation [Less Invasive
Surfactant Administration (LISA), Intubate Surfactant and Rapid
Extubation (INSURE) and mechanical ventilation following surfactant]
along with CPAP and NIPPV10.
In this systematic review, we critically review the different modes of
NRS and compare their effects in a NMA .