High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

Abstract

Objective To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). Study design This is aretrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤ 1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. Results A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035–1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. Conclusions In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants.

Effect of randomization of nasal high flow rate in preterm infants

“…It would have been useful to measure carbon dioxide values to help ascertain the exact mechanism of the relationship with oxygenation in the “nasal washout theory”. As there are studies showing that NHF is associated with a longer length of respiratory support and oxygen duration, a greater likelihood of developing BPD or death, a delay in establishing oral feeds, increased use of postnatal steroids and prolonged hospitalization in preterm infants, it is imperative that we investigate this further.…”

Nasal high flow therapy for neonates: Current evidence and future directions

“…Several retrospective cohort studies have demonstrated a longer duration of respiratory support or supplemental oxygen therapy in very preterm infants managed with nHF compared with CPAP . The interpretation of these studies is limited by methodological considerations; there may be significant differences in the severity of lung disease and other comorbidities between the groups.…”

Increased use of heated humidified high flow nasal cannula is associated with longer oxygen requirements

“…21 In a retrospective study by Taha et al the use of HFNC in extremely low birth weight infants was associated with a higher risk of death or bronchopulmonary dysplasia, increased respiratory morbidities and prolonged hospitalisation. 22 Another retrospective study by Hoffman et al of PBs <33 weeks GA found the HFNC group had higher rates of retinopathy of prematurity (ROP) and received a significantly longer duration of noninvasive respiratory support. 23 The more recent HIPSTER trial demonstrated a significant difference in treatment failure at 72 h between the HFNC (25.5%) and CPAP (13.3%) groups.…”

“…In a retrospective study by Taha et al . the use of HFNC in extremely low birth weight infants was associated with a higher risk of death or bronchopulmonary dysplasia, increased respiratory morbidities and prolonged hospitalisation . Another retrospective study by Hoffman et al .…”