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.