PS-284 Early Intubate-surfactant-extubate (insure) Versus Non-invasive Continuous Positive Airway Pressure (ncpap) To Prevent Bronchopulmonary Dysplasia: A Systematic Review And Meta-analysis

Background and aimsIn 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 (INSUR...

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Bibliographic Details
Published in:Archives of disease in childhood 2014-10, Vol.99 (Suppl 2), p.A214
Main Authors: Isayama, T, Chai-Adisaksopha, C, McDonald, S
Format: Article
Language:English
Subjects:
Continuous positive airway pressure
Data processing
Death
Dysplasia
Evidence-based medicine
Extubation
Hemorrhage
Infants
Intubation
Lung diseases
Meta Analysis
Mortality
Newborn babies
Pneumothorax
Premature Infants
Pressure
Respiratory distress syndrome
Respiratory therapy
Respiratory tract
Reviews
Statistical Significance
Statistics
Surfactants
Systematic review
Young Children
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Summary:Background and aimsIn 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.MethodsThis 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).ResultsNine 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).Abstract PS-284 Table 1OutcomesStudies(Number, N)INSURE(events, n/N)NCPAP(n/N)RR [95% CI]BPD5125/519146/5180.85[0.71,1.02]Death760/69863/7010.94[0.67,1.32]BPD or Death5175/569197/5690.88[0.76,1.02]Pneumothorax921/77543/7740.51[0.24,1.07]Sever intraventricular haemorrhage722/66029/6650.79[0.45,1.39]ConclusionsThe 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.
ISSN:0003-9888
1468-2044
DOI:10.1136/archdischild-2014-307384.584