Can high-flow nasal cannula reduce the risk of bronchopulmonary dysplasia compared with CPAP in preterm infants? A systematic review and meta-analysis

Abstract

Background Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects the premature lung, and to reduce its incidence has been used non-invasive ventilatory support, such as continuous positive airway (CPAP) and high-flow nasal cannula (HFNC). Thus, the objective of this review was to assess whether the use of high flow nasal cannula (HFNC) compared to continuous positive airway pressure (CPAP) decreases the risk of bronchopulmonary dysplasia (BPD) in premature newborns. Methods The protocol was registered (Prospero: CRD42019136631) and the search was conducted in the MEDLINE, PEDro, Cochrane Library, CINAHL, Embase, and LILACS databases, and in the clinical trials registries, until July 2020. We included randomized clinical trials comparing HFNC versus CPAP use in premature infants born at less than 37 weeks of gestational age. The main outcome measures were the development of BPD, air leak syndrome, and nasal injury. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool and the GRADE system was used to summarize the evidence recommendations. Meta-analyses were performed using software R. Results No difference was found between HFNC or CPAP for the risk of BPD (RR: 1.10; 95% CI: 0.90–1.34), air leak syndrome (RR: 1.06; 95% CI: 0.52–2.14), and nasal trauma (RR: 2.00; 95% CI: 0.64–6.25), with a very low level of evidence. Conclusion(s) The HFNC showed similar results when compared to CPAP in relation to the risk of BPD, air leak syndrome, and nasal injury. In the literature, no randomized clinical trial has been found with BPD as the primary outcome to support possible outcomes.

Noninvasive respiratory support following extubation in preterm infants

“…The complications of NCPAP are similar to those of HFNC; it has been reported that the incidence of nasal trauma with NCPAP is higher than that with HFNC 18,22 . Conversely, some reports have shown that the incidence does not differ between the two modes 23,24 . This may be due to the different possible methods to care for infants with NCPAP or HFNC in each institute.…”

“…18,22 Conversely, some reports have shown that the incidence does not differ between the two modes. 23,24 This may be due to the different possible methods to care for infants with NCPAP or HFNC in each institute. Feeding intolerance may also occur due to intestinal distension, called CPAP belly syndrome.…”

State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes

“…87 They found no difference for BPD rate (RR = 1.10, 95% CI = 0.90-1.34), 87 however, the quality of evidence was very low. 87 After the acute and most critical phase of respiratory disease, nHFT is often preferred by caregivers and family for simple usability and enhanced patients comfort. [88][89][90] Meta-analysis comparing nHFT with different noninvasive respiratory support modes in infants <37 weeks showed that nHFT is the most effective support mode for preventing nasal injury 84,85,91 nHFT compared to binasal prong CPAP reduce the risk of nasal injury with a risk difference −0.14, 95% CI = −0.17 to −0.10 (seven studies of 1570 neonates).…”

“…Identified risk factors for treatment failure were GA < 30 weeks and a fraction of inspired oxygen at start respiratory support >0.30 86 . A recent systematic review and meta‐analysis comparing nHFT and nCPAP looked at BPD as primary outcome in infants <37 weeks regardless of the timing of treatment initiation (13 RCTs, 2038 neonates) 87 . They found no difference for BPD rate (RR = 1.10, 95% CI = 0.90–1.34), 87 however, the quality of evidence was very low 87 .…”

“…A recent systematic review and meta‐analysis comparing nHFT and nCPAP looked at BPD as primary outcome in infants <37 weeks regardless of the timing of treatment initiation (13 RCTs, 2038 neonates) 87 . They found no difference for BPD rate (RR = 1.10, 95% CI = 0.90–1.34), 87 however, the quality of evidence was very low 87 . After the acute and most critical phase of respiratory disease, nHFT is often preferred by caregivers and family for simple usability and enhanced patients comfort 88–90 .…”