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Am J Perinatol 2025; 42(12): 1566-1575
DOI: 10.1055/a-2512-9531
Original Article

High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure on Postnatal Growth and Feeding in Preterm Infants: A Secondary Analysis of the NIPPN Study

Yohei Minamitani 
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
,
Shuntaro Oka
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
,
Naoyuki Miyahara
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
,
Mitsuhiro Haga 
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
,
Atsushi Uchiyama
2   Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Masaki Wada
3   Department of Neonatology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
,
Kaoru Okazaki
4   Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
,
Masatoshi Kondo
4   Department of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
,
Nobuhiko Nagano
5   Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi, Tokyo, Japan
,
Akira Kobayashi
6   Department of Neonatology, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan
,
Yoshiki Soeno
6   Department of Neonatology, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan
,
Hidehiko Maruyama
7   Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan
,
Yushi Ito
7   Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan
,
Fumihiko Namba
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
› Author Affiliations
Funding None.
› Further Information
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Abstract

Objective

High-flow nasal cannula (HFNC) is generally considered to have fewer enteral feeding problems than nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive-pressure ventilation (NIPPV). However, the effects of HFNC on the feeding outcomes in preterm infants are still controversial. The aim of this study was to assess the effect of HFNC on postnatal growth and feeding.

Study design

We conducted a secondary analysis of a multicenter randomized controlled trial. Preterm infants born <34 weeks were randomly assigned to the HFNC or NCPAP/NIPPV groups after initial extubation between 2015 and 2018. Data on postnatal growth and oral feeds were analyzed.

Results

Among 338 infants in the intention-to-treat analysis, the weight at 36 weeks in the HFNC group was significantly higher than that in the NCPAP/NIPPV group (1,926 vs. 1,804 g, p = 0.04). In the per-protocol analysis, HFNC showed increased daily weight gain from extubation to discharge after adjusting for confounding factors (24.2 vs. 22.4 g/day, adjusted difference 1.65 g/day, 95% confidence interval [CI]: 0.12–3.18). In the subgroup of infants born at 22 to 27 weeks, the weight at 36 weeks was significantly higher in the HFNC group (1,809 vs. 1,730 g, adjusted difference = 113.4 g, 95% CI: 5.0–221.8). There was no significant difference in time at initial and reached full oral feeding.

Conclusion

In preterm infants, especially extremely preterm infants, the use of HFNC may be associated with better weight gain.

Key Points

  • HFNC showed better weight gain compared with NCPAP/NIPPV in preterm infants.

  • HFNC was associated with higher weight at 36 weeks postmenstrual age in extremely preterm infants.

  • This study suggests that HFNC may have benefits in postnatal growth among extremely preterm infants.

Keywords

high-flow nasal cannula - noninvasive ventilation - preterm infant - weight gain - growth

Authors' Contributions

S.O., A.U., M.W., K.O., M.K., N.N., A.K., Y.S., H.M., and Y.I. are local investigators at the participating centers who made substantial contributions to the conception and design of the study, and interpretation of data. Y.M. performed statistical analyses, prepared the data tables, drafted the initial manuscript, and revised the manuscript. N.M., M.H., and F.N. are local investigators who made substantial contributions to the interpretation of data, and reviewed and revised the manuscript. All authors have read the draft and approved the final manuscript as submitted.


Data Availability

All datasets generated or analyzed during the current study are available from the corresponding author upon reasonable request.


Ethical Approval

Written informed consent was obtained from parents of all eligible infants before enrollment. Additional consent was waived by the Ethics Committee due to the nature of the study.




Publication History

Received: 21 September 2024

Accepted: 08 January 2025

Accepted Manuscript online:
09 January 2025

Article published online:
31 January 2025

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