Strengths and Limitations
This is one of the largest network meta-analysis evaluating the
different NRS modalities used as primary support for preterm neonates
with RDS. It is PRSIMA network meta-analysis extension compliant. The
quality of evidence for all the outcomes was done in a very robust
manner as per the GRADE working group recommendations.
Limitations in this network meta-analysis include that this did not
include two of the recently introduced NRS modalities in neonatal
respiratory care namely, nasal high frequency oscillation ventilation
(nHFOV) and neurally adjusted Ventilatory assist (NAVA). Also, two of
the secondary outcomes (NEC and Mortality) had inconsistent networks.
Finally, the event rates and the optimal information size for most of
the secondary outcomes were low with the quality of the evidence being
downgraded to low to very low for these outcomes.