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 .