Evaluation of the use of high-flow nasal cannula as primary respiratory support in late preterms

Objective Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the Neonatal Intensive Care Unit. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. Aim The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) as a primary mode for noninvasive respiratory support in the Neonatal Intensive Care Unit. Patients and methods This prospective comparative study was conducted on 100 late preterm neonates with gestational age 34–37 weeks with respiratory distress developed within 6 h of age. Patients were categorized into two groups: 50 received NCPAP and 50 received HHHFNC as a primary mode of respiratory support. The primary outcome was requirement for mechanical ventilation within 72 h of age. Secondary outcomes included need for mechanical ventilation beyond 72 h of age, occurrence of complications including nasal trauma, effect on feeding, and length of hospital stay. Results There was no difference in early failure for HHHFNC [1/50 (2.0%)] versus NCPAP [7/50 (14.0%); P=0.059], subsequent need for any intubation [6/50 vs. 8/50 (16%); P=0.564], or in any of several adverse outcomes analyzed, including air leak. NCPAP group had more cases that developed nasal trauma [18/50 (36.0%) vs. HHHFNC 0/50 (0.0%)]. No difference was found between both groups regarding the duration of hospital stay. Conclusion Among infants 34–37 weeks of gestational age, HHHFNC appears to have similar efficacy and safety to NCPAP when applied as a primary mode of respiratory support.