A comparative study of HHHFNC and NCPAP in preventing reintubation in extreme preterm infants born at less than 30-week gestation

Abstract

Introduction: Despite recent advances in respiratory support, the wide use of antenatal steroids and surfactant-replacement therapy, respiratory problems continue to represent the leading cause of mortality in premature infants during the neonatal period. In the last few years, HHHFNC has been widely adopted as a mode of noninvasive respiratory support for infants with respiratory difficulties. However, data of the safety and efficacy of HHHFNC use in extremely premature infants are scarce. This study will aid in bridging the knowledge gap and sheds light on the efficacy and, more importantly, the safety of HHHFNC as noninvasive respiratory support for extremely premature infants.Methods: This is a retrospective comparative study conducted at neonatal intensive care unit (NICU), Norfolk and Norwich University Hospital between 1 October 2010 and 31 December 2014. Data were collected from the medical notes and electronic records of the eligible patients. Participants’ total number was 26, 9 patients in nCPAP group while HHHFNC group consisted of 17 patients. The participants’ gestational age was ranging between 24 to 29 + 9 weeks who were supported by either nCPAP or HHHFNC after first extubation. Primary outcome was defined as the need for reintubation within 72-hour immediately postextubation, i.e. failure of noninvasive respiratory support.Results: Study showed no statistically significant differences in either primary (nCPAP (9/2 [22%]), HHHFNC (17/2 [12%]; p = .59)) or secondary outcomes (Constant need for O2 in the first 4 weeks of life (p = .62), pneumothorax (p = 1.0), nasal injury (p = .35)). p Value for spontaneous bowel perforation was not computed, as there were no affected patients.Conclusions: The study demonstrates that HHHFNC is similarly safe and efficacious in comparison to nCPAP as noninvasive respiratory support for extremely premature infants’ postextubation.