What do systematic reviews say?

NIPPV vs NCPAP

Nasal intermittent positive pressure ventilation (NIPPV) showed no clear difference in pneumothorax compared with nasal continuous positive airway pressure (NCPAP) (by population) (low certainty).

• Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure… 2023 · Cochrane Headline outcomes only
  RR 0.92 [0.6, 1.41]
  16 studies · 1674 participants
  Low

Bubble vs ventilator or Infant Flow Driver nasal continuous positive airway pressure (CPAP)

Bubble showed no clear difference in pneumothorax compared with ventilator or Infant Flow Driver nasal continuous positive airway… (low certainty).

• Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants 2023 · Cochrane Headline outcomes only
  RR 0.73 [0.4, 1.34]
  14 studies · 1340 participants
  Low

Early vs late continuous positive airway pressure (CPAP)

Early showed no clear difference in air leak (pneumothorax) compared with late continuous positive airway pressure (CPAP) (low certainty).

• Early versus delayed continuous positive airway pressure (CPAP) for respiratory distress in preterm infants 2020 · Cochrane Headline outcomes only
  RR 1.09 [0.39, 3.04]
  3 studies · 98 participants
  Low

HFNC vs nasal intermittent positive pressure ventilation

Nasal high flow showed no clear difference in pneumothorax (during assigned treatment) compared with nasal intermittent positive pressure ventilation (moderate certainty).

• Nasal high flow therapy for primary respiratory support in preterm infants 2023 · Cochrane Headline outcomes only
  RR 0.78 [0.4, 1.53]
  4 studies · 344 participants
  Moderate

HFNC vs continuous positive airway pressure (CPAP)

Nasal high flow showed no clear difference in pneumothorax (during assigned treatment) compared with continuous positive airway pressure (moderate certainty).

• Nasal high flow therapy for primary respiratory support in preterm infants 2023 · Cochrane Headline outcomes only
  RR 0.66 [0.4, 1.08]
  10 studies · 2094 participants
  Moderate

Surfactant treatment guided by rapid tests for surfactant deficiency vs surfactant therapy provided to preterm infants with respiratory distress syndrome diagnosed on clinical and radiologic criteria

Surfactant treatment guided by rapid tests for surfactant deficiency showed no clear difference in any pneumothorax№ of participants: 506(2 RCTs) compared with surfactant therapy provided to preterm infants with respiratory… (low certainty).

• Surfactant therapy guided by tests for lung maturity in preterm infants at risk of respiratory distress syndrome 2023 · Cochrane Headline outcomes only
  RR 0.53 [0.15, 1.92]
  Studies not reported
  Low

Salbutamol vs placebo

• Inhaled bronchodilators for the prevention and treatment of chronic lung disease in preterm infants 2024 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 173 participants
  Very low

Mask vs prongs

Mask showed no clear difference in pneumothorax compared with prongs (low certainty).

• Masks versus prongs as interfaces for nasal continuous positive airway pressure in preterm infants 2022 · Cochrane Headline outcomes only
  RR 0.93 [0.45, 1.93]
  5 studies · 625 participants
  Low

Use of initial sustained inflation vs standard inflations

Use of initial sustained inflation showed no clear difference in pneumothorax compared with standard inflations (low certainty).

• Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes 2020 · Cochrane Headline outcomes only
  RR 0.89 [0.57, 1.39]
  9 studies · 1458 participants
  Low

Volume‐targeted vs pressure‐limited ventilation: additional findings

Volume‐targeted probably leads to lower pneumothorax compared with pressure‐limited ventilation: main findings (moderate certainty).

• Volume‐targeted versus pressure‐limited ventilation in neonates 2017 · Cochrane Headline outcomes only
  RR 0.52 [0.31, 0.87]
  13 studies · 825 participants
  Moderate

Bovine lung lavage surfactant extract vs modified bovine minced lung surfactant extract

Bovine lung lavage surfactant extract showed no clear difference in pneumothorax compared with modified bovine minced lung surfactant extract (low certainty).

• Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm… 2015 · Cochrane Headline outcomes only
  RR 1.14 [0.85, 1.51]
  6 studies · 2224 participants
  Low

Bovine lung lavage surfactant extract vs porcine minced lung surfactant extract

The review found no eligible studies for this question.

• Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm… 2015 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Modified bovine minced lung surfactant extract vs porcine minced lung surfactant extract

Modified bovine minced lung surfactant extract showed no clear difference in pneumothorax compared with porcine minced lung surfactant extract (low certainty).

• Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm… 2015 · Cochrane Headline outcomes only
  RR 1.24 [0.71, 2.17]
  6 studies · 669 participants
  Low

Modified bovine minced lung surfactant extract vs porcine lung lavage surfactant

Modified bovine minced lung surfactant extract leads to lower pneumothorax compared with porcine lung lavage surfactant (high certainty).

• Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm… 2015 · Cochrane Headline outcomes only
  RR 0.1 [0.01, 0.73]
  1 study · 44 participants
  High

Bovine lung lavage surfactant extract vs modified bovine minced lung surfactant extract

Bovine lung lavage surfactant extract showed no clear difference in pneumothorax. compared with modified bovine minced lung surfactant extract (moderate certainty).

• Comparison of animal‐derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm… 2015 · Cochrane Headline outcomes only
  RR 0.76 [0.43, 1.36]
  1 study · 749 participants
  Moderate

Continuous positive airway pressure (CPAP) vs supplemental oxygen

CPAP may leads to higher pneumothorax occurring after allocation compared with supplemental oxygen (low certainty).

• Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants 2020 · Cochrane Headline outcomes only
  RR 2.91 [1.38, 6.13]
  4 studies · 270 participants
  Low

Prophylactic CPAP vs mechanical ventilation

Prophylactic CPAP showed no clear difference in pulmonary air leak defined as pneumothorax compared with mechanical ventilation (low certainty).

• Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants 2021 · Cochrane Headline outcomes only
  RR 1.24 [0.91, 1.69]
  3 studies · 2357 participants
  Low

Prophylactic or very early CPAP vs supportive care

Prophylactic or very early CPAP showed no clear difference in pulmonary air leak defined as pneumothorax compared with supportive care (low certainty).

• Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants 2021 · Cochrane Headline outcomes only
  RR 0.75 [0.35, 1.16]
  3 studies · 568 participants
  Low

Intervention not reported

• Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes 2020 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 9 participants
  Very low