Meta-Analysis:Safety And Efficacy Of HHHFNC VS NCPAP As Initial Treatment For Infants With Respiratory Distress

Objective:To evaluate the safety and efficacy of HHHFNC compared with NCPAP as the initial ventilation method for neonatal respiratory distress syndrome by META analysis,so as to provide evidence for clinical selection of appropriate non-invasive ventilation method for neonatal respiratory distress syndrome.Materials and methods:The PubMed,WanFng Data,The Cochrane Library,VIP,CJFD and CBMdisc were searched,and the retrieval time was from database establishment to database establishment until December 31,2018.Find out all about contrast HHHFNC NCPAP as the initial ventilatory mode controlled clinical study of treatment of neonatal respiratory distress syndrome,with ventilation rate(ventilation failure because of illness need to be invasive ventilation is refers to the children or change to other noninvasive assisted ventilation),mortality rate,oxygen exposure time,duration of time,to reach full enteral feeding milk statistics,statistical nasal injury,abdominal distension and ROP at the same time,the IVH incidence of clinical complications,such as with Revman5.3 software for analysis.The quality of included clinical studies was evaluated,the relevant data and data were extracted for META analysis,Revman5.3 software was used for analysis,funnel plot was used to evaluate publication bias,the possible causes of bias were analyzed,and sensitivity analysis was used to evaluate the stability of the results.Results:A total of the retrieved into standard clinical control study 21,issued a fixed number of year for 2012-2018,a total of 1721 children included in the analysis,including HHHFNC treatment group 862 examples,NCPAP treatment group 859 examples,extract the relevant data by META analysis,1.Main outcome indicators:the odds ratio(OR)ventilation rate is 0.53,95% ci(0.31,0.90),the P value is 0.02,of ventilation failure rate is lower than that HHHFNC group NCPAP group,the difference was statistically significant;Mortality OR was 0.55,95% confidence interval was [0.26,1.15],P value was 0.11,the difference was not statistically significant.Oxygen exposure time mean difference(MD)is-10.47,95% confidence interval [-16.82,-4.11],P value is 0.001,the open time of mean differences of-14.59,95% confidence interval [-18.26,-10.92],P values < 0.00001,the mean to reach full enteral feeding time difference value is-2.85,95% confidence interval [-3.88,-1.83],P values < 0.00001,suggesting HHHFNC group oxygen exposure time,milk and reach full enteral feeding time were shorter than NCPAP group,The difference was statistically significant.2.Secondary outcome indicators of the two groups: OR and95% confidence intervals of the incidence of abdominal distension and nasal injury were 0.18[0.12,0.47] and 0.16[0.11,0.24],respectively,indicating that the incidence of abdominal distension and nasal injury in the HHHFNC group was lower than that in the NCPAP group,and the difference was statistically significant.The OR and 95%confidence intervals of the incidence of BPD,neonatal intracranial hemorrhage,NEC,PDA,ROP,infection were 0.93[0.59,1.47] 、 0.96[0.57,1.62] 、 0.63[0.37,1.08] 、0.94[0.63,1.41] 、 1.01[0.61,1.68],and 0.76[0.48,1.19],the difference was not statistically significant.Conclusion:Compared with the traditional NCPAP HHHFNC for neonatal respiratory distress syndrome initial ventilation way,can reduce ventilation failure ratio,reduce its oxygen exposure time,shorten the time and time to reach full enteral feeding,milk at the same time reduce the nasal injury and the incidence of abdominal distension,does not increase with death and BPD,neonatal intracranial hemorrhage,NEC,PDA,ROP,the risk of infection.