The Comparison of HHHFNC and NCPAP in Extremely Low-Birth-Weight Preterm Infants After Extubation: A Single-Center Randomized Controlled Trial

Abstract

Objectives: To compare the clinical efficacy of heated, humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low-birth-weight preterm infants (ELBWI) after extubation. Methods: This trial included 94 extremely low-birth-weight infants (ELBWI), within 7 days after birth, and prepared for tracheal extubation and a change to non-invasive ventilation in the neonatal intensive care unit (NICU) admitted to our hospital from January 2015 to December 2018, with 48 infants in the HHHFNC group and 46 infants in the NCPAP group. Reintubation rate within 72 h after initial extubation, total ventilation time, non-invasive ventilation time, total oxygen inhalation time, and the time to reach full enteral feeding were the primary outcome measures. Total intestinal feeding time, average weight gain rate, days of hospitalization, costs of hospitalization, and complication rates, including nasal injury, IVH, BPD, NEC, ROP, and PDA, were used as secondary outcomes. Data were analyzed using Student's t -test or the Mann-Whitney U -test with a Chi-square test or Fisher's exact test, as appropriate, in SPSS (25.0). Results: HHHFNC not only shortened the oxygen exposure time but also effectively reduced the incidence of nasal injury (6.25 vs. 36.96%) and NEC (10.42 vs. 28.26%) ( P < 0.05). Additionally, HHHFNC achieved a significant advance in the time to reach full enteral feeding (31.24 ± 11.35 vs. 34.21 ± 14.09 days); increased the average weight gain rate (16.07 ± 3.10 vs. 13.74 ± 4.21) and reduced the days of hospitalization (73.45 ± 18.84 vs. 79.24 ± 19.75), with a lower cost of hospitalization (16.04 ± 3.64 vs.18.79 ± 4.13) thousand dollars (all P < 0.05). Conclusions: Compared with NCPAP, HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI. HHHFNC shortens oxygen consumption time and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the length of stay and the hospitalization costs.

Is There a Decreased Risk of Bronchopulmonary Dysplasia Treated With High-Flow Nasal Cannulae Compared to Cpap? A Systematic Review and Meta-Analysis of Randomized Clinical Trial

“…The electronic and hand searches identi ed a total of 2004 articles. After removal of duplicates, 1124 articles were screened of which 15 articles met the inclusion criteria [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . The steps for selecting articles and the reason for exclusions are described in the PRISMA ow diagram (Figure 1).…”

“…In relation to the use of the intervention (HFNC) and its comparator (CPAP), most studies evaluated extubation failure in the rst 72 hours as the primary outcome 10,11,19,21,[24][25][26] . The others evaluated chronic lung disease after extubation 28 , higher oxygen use requirement 29 , treatment respiratory distress syndrome (RDS) primary 22,24,28 , effectiveness and safety of HNFC and oral feeding 18,20,21,27 .…”

“…Fourteen studies comprising 2215 patients were included in the meta-analysis for BPD outcome 10,11,[17][18][19][20][21]24,[26][27][28][29] . There was no difference between the use of HFNC and CPAP in the development of BPD (RR:…”

“…To reduce the incidence of BPD, a signi cant increase in the use of non-invasive ventilatory support, such as continuous positive airway pressure (CPAP), which provides stability to the newborn's airways, increasing the gas exchange area and decreasing respiratory work, thus reducing the need for invasive mechanical ventilation have been used [5][6][7] . New modalities of non-invasive ventilation strategies include the use of the high-ow nasal cannula (HFNC) 6,8 , whose bene ts include decreased airway resistance and better gas exchange, reducing respiratory overload [9][10][11][12] .…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…However, the rate of BPD was not significantly different in the two groups (34% vs. 38%, p = 0.34) [ 73 ]. In contrast, two recent RCTs comparing HFNC to NCPAP as post-extubation support in premature infants showed that HFNC was as effective as NCPAP in preventing extubation failure, without any differential impact on BPD [ 74 , 75 ]. It is important to acknowledge the slight variation in the flow rates used in all the above studies, but the trials examining HFNC as primary mode used 5–8 L/min, and the ones that evaluated its role as post-extubation support used 3–7 L/min.…”