Background and aims In preterm infants, early non-invasive continuous positive airway pressure (NCPAP) use decreases “bronchopulmonary dysplasia (BPD) or death” compared with early intubation. However, it was not yet clear whether early Intubation-for-SURfactant-followed-by-Extubation to NCPAP (INSURE) is more effective to prevent BPD or Death or “BPD or death” or either than keeping infants on NCPAP. This systematic review aimed to investigate this question.
Methods This systematic review included randomised control trials comparing the INSURE and NCPAP for preterm infants with or at high risk of respiratory distress syndrome who had never been intubated before the study entry. Primary outcomes included BPD at 36 weeks postmenstrual age, Death, and “BPD or Death”. A systematic literature search was conducted of MEDLINE, EMBASE, CENTRAL, and CINAHL as well as conference proceedings and trial registrations. Two reviewers independently selected studies and extracted data. Meta-analyses were conducted with a random-effect method using Review manager 5.2 (statistical significance with two-sided p-value of 0.05).
Results Nine trials were included from 1622 non-duplicate records. The meta-analysis results were shown in a table with pooled risk ratios (RR) and 95% confidence interval (CI).
Conclusions The rates of BPD, Death or “BPD or Death” were lower in infants receiving INSURE versus NCPAP group although, the differences did not reach statistical significance.