Comparison of efficacy of nasal continuous positive airway pressure and heated humidified high-flow nasal cannula as a primary mode of respiratory support in preterm infants

Abstract

Background: Nasal continuous positive airway pressure (NCPAP) is a well-recognized mode of noninvasive respiratory support (NIV) for newborns with respiratory distress. Evidence for the heated humidified high-flow nasal cannula (HHHFNC) as an alternative mode of respiratory support is scarce. The aim of this work was to evaluate whether HHHFNC is equally efficacious to NCPAP as providing primary respiratory support in the first 6 h of life for preterm neonates with respiratory distress. Methods: Preterm infants (gestation 26–34 weeks) with respiratory distress were randomized to either HHHFNC or NCPAP. The primary outcomes of the study were inferred in terms of total duration of NIV support (in hours) and total duration of oxygen supplementation (NIV + oxyhood/oxygen by nasal prongs) required. The secondary outcomes measured and compared between the two study groups were total time taken to reach full feeds; incidence and severity of nasal trauma; incidence of air leaks, bronchopulmonary dysplasia, patent ductus arteriosus, and retinopathy of prematurity. Results: The mean duration of NIV support in NCPAP and HHHFNC group was 69.1 ± 37.75 and 67.57 ± 45.48 h, respectively (P = 0.867). The mean durations of total oxygen supplementation in NCPAP and HHHFNC groups were 96.88 ± 100 and 83.73 ± 107 h, respectively (P = 0.062). The failure rate was similar in both the study groups (P = 1.000). Conclusions: We conclude from the present study that HHHFNC is equally efficacious to NCPAP as a primary mode of respiratory support for respiratory distress in preterm infants.