Aim Nasal high frequency oscillatory ventilation (NHFOV) has emerged as a novel ventilation mode for primary support in preterm infants with respiratory distress syndrome (RDS). This study aims to evaluate whether NHFOV can diminish the need for intubation in the treatment of preterm infants with RDS, thereby establishing itself as a primary respiratory support modality.

Material and Method A comprehensive literature search spanning from 2013 to 2023 was conducted across various databases, including PubMed, Google Scholar, Science Direct, Ebsco, Proquest, Wiley Online, the Cochrane Library, Scopus, supplemented by hand searches. The primary outcome measured was the intubation rate, with secondary outcomes encompassing mortality rate, duration of non-invasive ventilation (NIV), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), air leaks, and necrotizing enterocolitis (NEC). Meta-analyses were performed using calculation sheets from Meta-Essentials, developed by the Erasmus Research Institute of Management.

Results Eight randomized controlled trials involving 994 preterm infants demonstrated a reduced intubation rate with NHFOV compared to other NIV methods, including nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), and bilevel positive airway pressure (BiPAP), with a risk reduction (RR) of 0.59 (95% CI 0.29–0.92; I2 16.19%, p=0.04). Subgroup analysis highlighted NHFOV’s superiority over NCPAP, exhibiting an RR of 0.47 (95% CI 0.32–0.70; I2 0%, p = 0.00). The NHFOV group also demonstrated a significantly shorter duration of NIV compared to other NIV methods, with a mean difference of 0.51 hours (95% CI 0.13–0.89 hours; I2 77%, p=0.00). However, rates of mortality, IVH, ROP, BPD, air leaks, and NEC did not significantly differ between the two groups.

Conclusions NHFOV effectively reduced the necessity for intubation and shortened the duration of NIV in preterm infants with RDS, without significantly altering the rates of complications when compared to other NIV methods