High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates

Abstract

Abstract Objective To determine whether the availability of heated humidified high-flow nasal cannula (HFNC) therapy was associated with a decrease in need for mechanical ventilation in neonates hospitalised with acute bronchiolitis. Methods A combined retrospective and prospective (ambispective) cohort study was performed in a type II-B Neonatal Unit, including hospitalised neonates with acute bronchiolitis after the introduction of HFNC (HFNC-period; October 2011–April 2015). They were compared with a historical cohort prior to the availability of this technique (pre-HFNC; January 2008–May 2011). The need for mechanical ventilation between the two study groups was analysed. Clinical parameters and technique-related complications were evaluated in neonates treated with HFNC. Results A total of 112 neonates were included, 56 after the introduction of HFNC and 56 from the period before the introduction of HFNC. None of the patients in the HFNC-period required intubation, compared with 3.6% of the patients in the pre-HFNC group. The availability of HFNC resulted in a significant decrease in the need for non-invasive mechanical ventilation (30.4% vs 10.7%; P = .01), with a relative risk (RR) of .353 (95% CI: .150–.829), an absolute risk reduction (ARR) of 19.6% (95% CI: 5.13–34.2), yielding a NNT of 5. In the HFNC-period, 22 patients received high flow therapy, and 22.7% (95% CI: 7.8–45.4) required non-invasive ventilation. Treatment with HFNC was associated with a significant decrease in heart rate ( P = .03), respiratory rate ( P = .01), and an improvement in the Wood-Downes-Ferres score ( P = .00). No adverse effects were observed. Conclusions The availability of HFNC reduces the need for non-invasive mechanical ventilation, allowing a safe and effective medical management of neonates with acute bronchiolitis.