Interventions to improve the rate of successful extubation in preterm infants: a meta-analysis_West China Medical Journal

Authors：

MU Yuju ,  WANG Hua , MU Dezhi

Department of Neonatology, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WANG Hua, Email: wanghua@scu.edu.cn

Keywords：

Preterm infants; Noninvasive respiratory support; Caffeine; Extubation; Meta-analysis

DOI：

10.7507/1002-0179.202011167

Video：

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Objective To systematically review the effectiveness and safety of interventions which target to improve the rate of successful extubation in preterm infants.Methods PubMed, Web of Science, Cochrane Library, Chongqing VIP database, China National Knowledge Infrastructure, and Wanfang Database were searched for articles published from the dates of establishment of databases to August 2020, which compared different noninvasive respiratory support models or different doses of caffeine to improve the rate of successful extubation in preterm infants in randomized controlled trials. The references of included articles were also retrieved. And then a meta-analysis was performed by using RevMan 5.3 software.Results A total of 33 randomized controlled trials involving 4 536 preterm infants were included. Compared with nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC) reduced the nose injury rate [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.15, 0.57), P=0.000 3] and the pneumothorax rate [OR=0.18, 95%CI (0.06, 0.55), P=0.003]; nasal intermittent positive pressure ventilation (NIPPV) reduced the extubation failure rate [OR=0.33, 95%CI (0.23, 0.48), P<0.000 01], the reintubation rate [OR=0.36, 95%CI (0.20, 0.65), P=0.000 7], the respiratory failure rate [OR=0.33, 95%CI (0.17, 0.64), P=0.000 9], and the pneumothorax rate [OR=0.29, 95%CI (0.12, 0.70), P=0.006]; and biphasic positive airway pressure (BiPAP) reduced the reintubation rate [OR=0.21, 95%CI (0.09, 0.46), P=0.000 1]. Compared with low-dose caffeine, high-dose caffeine reduced the extubation failure rate [OR=0.44, 95%CI (0.32, 0.60), P<0.000 01] and the bronchopulmonary dysplasia rate [OR=0.69, 95%CI (0.48, 0.99), P=0.04], but increased the rate of tachycardia [OR=1.99, 95%CI (1.22, 3.25), P=0.006].Conclusion According to the current evidence, compared with NCPAP, NIPPV and BiPAP could be used to improve the rate of successful extubation in preterm infants, HFNC could be used to decrease the risk of nose injury and pneumothorax; the optimal dose of caffeine should be chosen after evaluating the risk of adverse reactions such as tachycardia.

Citation： MU Yuju, WANG Hua, MU Dezhi. Interventions to improve the rate of successful extubation in preterm infants: a meta-analysis. West China Medical Journal, 2021, 36(8): 1083-1092. doi: 10.7507/1002-0179.202011167 Copy

1.	Ferguson KN, Roberts CT, Manley BJ, et al. Interventions to improve rates of successful extubation in preterm infants: a systematic review and meta-analysis. JAMA Pediatr, 2017, 171(2): 165-174.
2.	Costa AC, Schettino Rde C, Ferreira SC. Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation. Rev Bras Ter Intensiva, 2014, 26(1): 51-56.
3.	Hermeto F, Bottino MN, Vaillancourt K, et al. Implementation of a respiratory therapist-driven protocol for neonatal ventilation: impact on the premature population. Pediatrics, 2009, 123(5): e907-e916.
4.	Al Mandhari H, Finelli M, Chen S, et al. Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit. Can J Respir Ther, 2019, 55: 81-88.
5.	Andrade LB, Melo TM, Morais DF, et al. Spontaneous breathing trial evaluation in preterm newborns extubation. Rev Bras Ter Intensiva, 2010, 22(2): 159-165.
6.	Chawla S, Natarajan G, Gelmini M, et al. Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatr Pulmonol, 2013, 48(5): 443-448.
7.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. (2011-03-01)[2018-11-03]. http://handbook.cochrane.org.
8.	Campbell DM, Shah PS, Shah V, et al. Nasal continuous positive airway pressure from high flow cannula versus infant flow for preterm infants. J Perinatol, 2006, 26(9): 546-549.
9.	Yoder BA, Stoddard RA, Li M, et al. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics, 2013, 131(5): e1482-e1490.
10.	Manley BJ, Owen LS, Doyle LW, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med, 2013, 369(15): 1425-1433.
11.	Kadivar MM, Mosayebi ZM, Razi NM, et al. High flow nasal cannulae versus nasal continuous positive airway pressure in neonates with respiratory distress syndrome managed with INSURE method: a randomized clinical trial. Iran J Med Sci, 2016, 41(6): 494-500.
12.	Collins CL, Holberton JR, Barfield C, et al. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr, 2013, 162(5): 949-954.
13.	Soonsawad S, Swatesutipun B, Limrungsikul A, et al. Heated humidified high-flow nasal cannula for prevention of extubation failure in preterm infants. Indian J Pediatr, 2017, 84(4): 262-266.
14.	潘健崧, 陳宏香, 溫園香. 濕化高流量鼻導管通氣預防超低出生體質量兒拔管失敗臨床分析. 深圳中西醫結合雜志, 2017, 27(3): 77-79.
15.	鄭紅玲. 加溫濕化經鼻導管高流量通氣預防超低出生體重早產兒拔管失敗的臨床觀察. 醫藥論壇雜志, 2017, 38(7): 88-89.
16.	魏賢, 甘斌, 何源, 等. HHFNC和NCPAP在早產兒機械通氣撤機中的應用. 河南醫學研究, 2018, 27(4): 594-597.
17.	Friedlich P, Lecart C, Posen R, et al. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol, 1999, 19(6 Pt 1): 413-418.
18.	Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics, 2001, 107(4): 638-641.
19.	Khalaf MN, Brodsky N, Hurley J, et al. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics, 2001, 108(1): 13-17.
20.	Moretti C, Giannini L, Fassi C, et al. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial. Pediatr Int, 2008, 50(1): 85-91.
21.	Khorana M, Paradeevisut H, Sangtawesin V, et al. A randomized trial of non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV) vs. nasal continuous positive airway pressure (NCPAP) in the prevention of extubation failure in pre-term< 1, 500 grams. J Med Assoc Thai, 2008, 91(Suppl 3): S136-S142.
22.	O’Brien K, Campbell C, Brown L, et al. Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants’ ≤ 1, 250 grams: a randomized controlled trial. BMC Pediatr, 2012, 12: 43.
23.	Kirpalani H, Millar D, Lemyre B, et al. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med, 2013, 369(7): 611-620.
24.	Kahramaner Z, Erdemir A, Turkoglu E, et al. Unsynchronized nasal intermittent positive pressure versus nasal continuous positive airway pressure in preterm infants after extubation. J Matern Fetal Neonatal Med, 2014, 27(9): 926-929.
25.	Komatsu DF, Diniz EM, Ferraro AA, et al. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation. Rev Assoc Med Bras (1992), 2016, 62(6): 568-574.
26.	Jasani B, Nanavati R, Kabra N, et al. Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med, 2016, 29(10): 1546-1551.
27.	丁斐, 張文雅, 趙育弘, 等. 早產兒RDS撤機后不同模式無創通氣治療的臨床研究. 安徽醫科大學學報, 2019, 54(12): 1982-1985.
28.	江云. 經鼻間歇指令通氣與經鼻持續正壓通氣在早產兒撤機后的應用. 中國當代醫藥, 2020, 27(19): 129-132.
29.	張俊亮. 鼻式間歇正壓通氣用于早產兒拔管的臨床研究. 廣州: 南方醫科大學, 2013.
30.	段景輝, 李劍芳, 官素玲. 鼻塞雙水平正壓通氣應用于≤32周早產兒拔管的臨床研究. 中國臨床研究, 2015, 28(7): 926-928.
31.	Victor S, Roberts SA, Mitchell S, et al. Biphasic positive airway pressure or continuous positive airway pressure: a randomized trial. Pediatrics, 2016, 138(2): e20154095.
32.	李琳, 陳麗萍, 余曼莉, 等. nBiPAP和nCPAP在新生兒呼吸窘迫綜合征中作為撤機后呼吸支持治療的效果比較. 中國現代醫生, 2019, 57(23): 66-69.
33.	余鵬程. 不同劑量咖啡因聯合NIPPV輔助極低出生體重兒拔管研究. 黑龍江醫藥, 2020, 33(1): 92-94.
34.	Gray PH, Flenady VJ, Charles BG, et al. Caffeine citrate for very preterm infants: effects on development, temperament and behaviour. J Paediatr Child Health, 2011, 47(4): 167-172.
35.	Mohammed S, Nour I, Shabaan AE, et al. High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial. Eur J Pediatr, 2015, 174(7): 949-956.
36.	Steer PA, Flenady VJ, Shearman A, et al. Periextubation caffeine in preterm neonates: a randomized dose response trial. J Paediatr Child Health, 2003, 39(7): 511-515.
37.	Steer P, Flenady V, Shearman A, et al. High dose caffeine citrate for extubation of preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed, 2004, 89(6): F499-F503.
38.	范莉莉, 王婷, 王佐. 不同劑量咖啡因治療早產兒原發性呼吸暫停的臨床療效研究. 中國全科醫學, 2017, 20(10): 1204-1207.
39.	胡曉明, 米榮, 李馳, 等. 枸櫞酸咖啡因劑量差異對呼吸暫停早產兒拔管失敗率、并發癥及不良反應的影響. 中國婦幼保健, 2018, 33(13): 2979-2982.
40.	王娟, 姜善雨, 周勤, 等. 高維持劑量枸櫞酸咖啡因對極超低出生體重兒呼吸暫停的臨床作用研究. 東南大學學報(醫學版), 2018, 37(5): 872-876.
41.	Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev, 2000(2): CD000143.
42.	Wilkinson D, Andersen C, O’Donnell CP, et al. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev, 2016, 2: CD006405.
43.	Hough JL, Shearman AD, Jardine LA, et al. Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey. J Paediatr Child Health, 2012, 48(2): 106-113.
44.	Nath P, Ponnusamy V, Willis K, et al. Current practices of high and low flow oxygen therapy and humidification in UK neonatal units. Pediatr Int, 2010, 52(6): 893-894.
45.	Manley BJ, Dold SK, Davis PG, et al. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology, 2012, 102(4): 300-308.
46.	Conte F, Orfeo L, Gizzi C, et al. Rapid systematic review shows that using a high-flow nasal cannula is inferior to nasal continuous positive airway pressure as first-line support in preterm neonates. Acta Paediatr, 2018, 107(10): 1684-1696.
47.	Kotecha SJ, Adappa R, Gupta N, et al. Safety and efficacy of high-flow nasal cannula therapy in preterm infants: a meta-analysis. Pediatrics, 2015, 136(3): 542-553.
48.	馮宗太, 楊祖銘, 顧丹鳳, 等. 加溫濕化高流量鼻導管通氣預防新生兒拔管失敗的Meta分析. 中國當代兒科雜志, 2015, 17(12): 1327-1332.
49.	Lemyre B, Davis PG, De Paoli AG, et al. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev, 2017(2): CD003212.
50.	崔娜娜. 咖啡因治療早產兒呼吸暫停療效及安全性的meta分析. 洛陽: 河南科技大學, 2019.

1. Ferguson KN, Roberts CT, Manley BJ, et al. Interventions to improve rates of successful extubation in preterm infants: a systematic review and meta-analysis. JAMA Pediatr, 2017, 171(2): 165-174.
2. Costa AC, Schettino Rde C, Ferreira SC. Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation. Rev Bras Ter Intensiva, 2014, 26(1): 51-56.
3. Hermeto F, Bottino MN, Vaillancourt K, et al. Implementation of a respiratory therapist-driven protocol for neonatal ventilation: impact on the premature population. Pediatrics, 2009, 123(5): e907-e916.
4. Al Mandhari H, Finelli M, Chen S, et al. Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit. Can J Respir Ther, 2019, 55: 81-88.
5. Andrade LB, Melo TM, Morais DF, et al. Spontaneous breathing trial evaluation in preterm newborns extubation. Rev Bras Ter Intensiva, 2010, 22(2): 159-165.
6. Chawla S, Natarajan G, Gelmini M, et al. Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatr Pulmonol, 2013, 48(5): 443-448.
7. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. (2011-03-01)[2018-11-03]. http://handbook.cochrane.org.
8. Campbell DM, Shah PS, Shah V, et al. Nasal continuous positive airway pressure from high flow cannula versus infant flow for preterm infants. J Perinatol, 2006, 26(9): 546-549.
9. Yoder BA, Stoddard RA, Li M, et al. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics, 2013, 131(5): e1482-e1490.
10. Manley BJ, Owen LS, Doyle LW, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med, 2013, 369(15): 1425-1433.
11. Kadivar MM, Mosayebi ZM, Razi NM, et al. High flow nasal cannulae versus nasal continuous positive airway pressure in neonates with respiratory distress syndrome managed with INSURE method: a randomized clinical trial. Iran J Med Sci, 2016, 41(6): 494-500.
12. Collins CL, Holberton JR, Barfield C, et al. A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr, 2013, 162(5): 949-954.
13. Soonsawad S, Swatesutipun B, Limrungsikul A, et al. Heated humidified high-flow nasal cannula for prevention of extubation failure in preterm infants. Indian J Pediatr, 2017, 84(4): 262-266.
14. 潘健崧, 陳宏香, 溫園香. 濕化高流量鼻導管通氣預防超低出生體質量兒拔管失敗臨床分析. 深圳中西醫結合雜志, 2017, 27(3): 77-79.
15. 鄭紅玲. 加溫濕化經鼻導管高流量通氣預防超低出生體重早產兒拔管失敗的臨床觀察. 醫藥論壇雜志, 2017, 38(7): 88-89.
16. 魏賢, 甘斌, 何源, 等. HHFNC和NCPAP在早產兒機械通氣撤機中的應用. 河南醫學研究, 2018, 27(4): 594-597.
17. Friedlich P, Lecart C, Posen R, et al. A randomized trial of nasopharyngeal-synchronized intermittent mandatory ventilation versus nasopharyngeal continuous positive airway pressure in very low birth weight infants after extubation. J Perinatol, 1999, 19(6 Pt 1): 413-418.
18. Barrington KJ, Bull D, Finer NN. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants. Pediatrics, 2001, 107(4): 638-641.
19. Khalaf MN, Brodsky N, Hurley J, et al. A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation. Pediatrics, 2001, 108(1): 13-17.
20. Moretti C, Giannini L, Fassi C, et al. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial. Pediatr Int, 2008, 50(1): 85-91.
21. Khorana M, Paradeevisut H, Sangtawesin V, et al. A randomized trial of non-synchronized nasopharyngeal intermittent mandatory ventilation (nsNIMV) vs. nasal continuous positive airway pressure (NCPAP) in the prevention of extubation failure in pre-term< 1, 500 grams. J Med Assoc Thai, 2008, 91(Suppl 3): S136-S142.
22. O’Brien K, Campbell C, Brown L, et al. Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants’ ≤ 1, 250 grams: a randomized controlled trial. BMC Pediatr, 2012, 12: 43.
23. Kirpalani H, Millar D, Lemyre B, et al. A trial comparing noninvasive ventilation strategies in preterm infants. N Engl J Med, 2013, 369(7): 611-620.
24. Kahramaner Z, Erdemir A, Turkoglu E, et al. Unsynchronized nasal intermittent positive pressure versus nasal continuous positive airway pressure in preterm infants after extubation. J Matern Fetal Neonatal Med, 2014, 27(9): 926-929.
25. Komatsu DF, Diniz EM, Ferraro AA, et al. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation. Rev Assoc Med Bras (1992), 2016, 62(6): 568-574.
26. Jasani B, Nanavati R, Kabra N, et al. Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial. J Matern Fetal Neonatal Med, 2016, 29(10): 1546-1551.
27. 丁斐, 張文雅, 趙育弘, 等. 早產兒RDS撤機后不同模式無創通氣治療的臨床研究. 安徽醫科大學學報, 2019, 54(12): 1982-1985.
28. 江云. 經鼻間歇指令通氣與經鼻持續正壓通氣在早產兒撤機后的應用. 中國當代醫藥, 2020, 27(19): 129-132.
29. 張俊亮. 鼻式間歇正壓通氣用于早產兒拔管的臨床研究. 廣州: 南方醫科大學, 2013.
30. 段景輝, 李劍芳, 官素玲. 鼻塞雙水平正壓通氣應用于≤32周早產兒拔管的臨床研究. 中國臨床研究, 2015, 28(7): 926-928.
31. Victor S, Roberts SA, Mitchell S, et al. Biphasic positive airway pressure or continuous positive airway pressure: a randomized trial. Pediatrics, 2016, 138(2): e20154095.
32. 李琳, 陳麗萍, 余曼莉, 等. nBiPAP和nCPAP在新生兒呼吸窘迫綜合征中作為撤機后呼吸支持治療的效果比較. 中國現代醫生, 2019, 57(23): 66-69.
33. 余鵬程. 不同劑量咖啡因聯合NIPPV輔助極低出生體重兒拔管研究. 黑龍江醫藥, 2020, 33(1): 92-94.
34. Gray PH, Flenady VJ, Charles BG, et al. Caffeine citrate for very preterm infants: effects on development, temperament and behaviour. J Paediatr Child Health, 2011, 47(4): 167-172.
35. Mohammed S, Nour I, Shabaan AE, et al. High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial. Eur J Pediatr, 2015, 174(7): 949-956.
36. Steer PA, Flenady VJ, Shearman A, et al. Periextubation caffeine in preterm neonates: a randomized dose response trial. J Paediatr Child Health, 2003, 39(7): 511-515.
37. Steer P, Flenady V, Shearman A, et al. High dose caffeine citrate for extubation of preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed, 2004, 89(6): F499-F503.
38. 范莉莉, 王婷, 王佐. 不同劑量咖啡因治療早產兒原發性呼吸暫停的臨床療效研究. 中國全科醫學, 2017, 20(10): 1204-1207.
39. 胡曉明, 米榮, 李馳, 等. 枸櫞酸咖啡因劑量差異對呼吸暫停早產兒拔管失敗率、并發癥及不良反應的影響. 中國婦幼保健, 2018, 33(13): 2979-2982.
40. 王娟, 姜善雨, 周勤, 等. 高維持劑量枸櫞酸咖啡因對極超低出生體重兒呼吸暫停的臨床作用研究. 東南大學學報(醫學版), 2018, 37(5): 872-876.
41. Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev, 2000(2): CD000143.
42. Wilkinson D, Andersen C, O’Donnell CP, et al. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev, 2016, 2: CD006405.
43. Hough JL, Shearman AD, Jardine LA, et al. Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey. J Paediatr Child Health, 2012, 48(2): 106-113.
44. Nath P, Ponnusamy V, Willis K, et al. Current practices of high and low flow oxygen therapy and humidification in UK neonatal units. Pediatr Int, 2010, 52(6): 893-894.
45. Manley BJ, Dold SK, Davis PG, et al. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology, 2012, 102(4): 300-308.
46. Conte F, Orfeo L, Gizzi C, et al. Rapid systematic review shows that using a high-flow nasal cannula is inferior to nasal continuous positive airway pressure as first-line support in preterm neonates. Acta Paediatr, 2018, 107(10): 1684-1696.
47. Kotecha SJ, Adappa R, Gupta N, et al. Safety and efficacy of high-flow nasal cannula therapy in preterm infants: a meta-analysis. Pediatrics, 2015, 136(3): 542-553.
48. 馮宗太, 楊祖銘, 顧丹鳳, 等. 加溫濕化高流量鼻導管通氣預防新生兒拔管失敗的Meta分析. 中國當代兒科雜志, 2015, 17(12): 1327-1332.
49. Lemyre B, Davis PG, De Paoli AG, et al. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev, 2017(2): CD003212.
50. 崔娜娜. 咖啡因治療早產兒呼吸暫停療效及安全性的meta分析. 洛陽: 河南科技大學, 2019.

West China Medical Journal

Interventions to improve the rate of successful extubation in preterm infants: a meta-analysis

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