High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants: A Prospective Randomized Study

Abstract

Objective This study compares high flow nasal cannula (HFNC) with nasal continuous positive airway pressure (nCPAP) within the first hour of life as the primary respiratory support in neonates of ≤32 weeks of gestational age.

Study Design This prospective, randomized study was conducted in infants with a gestational age of ≤32 weeks who had spontaneous respiration. HFNC or nCPAP was used as a first line respiratory support after admission to intensive care unit. Primary outcome was primary treatment failure. Secondary outcomes were duration of noninvasive respiratory support and oxygen treatment, maximum FiO₂ level, length of hospital stay, intubation rate, rates of respiratory distress syndrome, pneumothorax, and bronchopulmonary dysplasia. Subgroup analysis was performed for infants ≤28 weeks of gestational age.

Results We enrolled 107 infants, 53 in HFNC and 54 to nCPAP group. There was no difference in primary outcome between the two groups. There was no difference between the groups in aspect of secondary outcomes.

Conclusion HFNC and nCPAP have no significant differences as a primary mode of respiratory support in preterm infants, in the time to wean off the devices and oxygen support, respiratory distress syndrome and bronchopulmonary dysplasia incidence, hospitalization duration, and rates of complications of prematurity.

Keywords

high flow nasal cannula - nasal continuous positive airway pressure - preterm infant - respiratory distress

Authors' Contributions

G.D. conceptualized and designed the study, drafted initial manuscript and reviewed and revised the manuscript, performed analyses. B.V. collected data and supervised data collection. A.T. reviewed the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Ethical Approval

Subjects (or their parents or guardians) have given their written informed consent. The study protocol has been approved by the Istanbul Medipol University Research Institute's Committee on Human Research.

Publication History

Received: 21 May 2019

Accepted: 26 July 2019

Article published online:
28 September 2019

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