The Effectiveness of the Heated Humidified High Flow Nasal Cannula as an Initial Noninvasive Respiratory Support for Preterm Infants Suffering from Respiratory Distress

Aims: to compare the efficacy and safety of the heated humidified high-flow nasal cannula as a noninvasive respiratory support for the initial management of respiratory distress in preterm infants ≥ 30 weeks gestation with birth weight ≥ 1300 g at different flow rates (3 L/min and 6 L/min) on admission.

Study Design: A Randomized controlled trial.

Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019.

Methodology: 30 preterm neonates, with gestational ages ranged between 30 to 36 weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min as an initial respiratory support. Primary outcomes included: the incidence of treatment failure of the HHHFNC at flow 3 L/min and 6 L/min, which will require n CPAP or NIMV, or will require intubation. Secondary outcomes included: rate of deaths at any time after randomization, the total duration of all types of oxygen support and incidence of neonatal morbidities such as nasal trauma, symptomatic patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH ≥ grade II), pneumothorax, pulmonary hemorrhage, retinopathy of prematurity (ROP), apnea, sepsis and necrotizing enterocolitis (NEC ≥ stage II).

Results: the incidence of the need for higher flow rate of HHHFNC (n=11, 36.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n=11, 36.6%), the need for intubation & MV (n=1, 3.3%), the incidence of nasal trauma (n=7, 23.3%), BPD (n=0) , IVH ≥ II (n=0), NEC ≥II (n=0), pneumothorax (n=0) , the median duration of hospitalization =10 days (7-15), the median duration of all oxygen support = 6.5 days (6-7). The failure rate was 11 out of 30 infants (36.6%), no deaths or pulmonary haemorrhage.

Conclusion: HHHFNC use shows similar rates of efficacy to other forms of noninvasive respiratory support in preterm infants with respiratory distress for initial respiratory support with lesser complications. There were better outcomes with higher gestational age and birth weight at either flow rates 3 or 6 L/min.