A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants

Abstract

Background: Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of ‘atelectotrauma', potentially promoting lung development in neonates. Objectives: To assess whether replacing nCPAP by low-flow O₂ by nasal cannula affects lung function expressed as the arterial/alveolar oxygen tension ratio (a/A pO₂ ratio) on postnatal day 28. Methods: Preterm infants (birth weight <1,500 g and gestational age, GA >26 + 0 weeks) stable on nCPAP between postnatal days 4 and 7 were randomized to nCPAP or low-flow O₂ by nasal cannula (<0.2 liters/min). Study criteria defined how to wean/restart respiratory support or change from low-flow O₂ to nCPAP and vice versa. Transcutaneous monitoring was used for the assessment of the a/A pO₂ ratio on day 28 using a head box for all infants for accurate measurement and to eliminate possible effects from nCPAP or low-flow O₂ on oxygen requirement. Results: We enrolled 52 infants (nCPAP group n = 30 and low-flow O₂ group n = 22). The a/A pO₂ ratio at 28 days was 0.43 ± 0.17 (nCPAP group) versus 0.48 ± 0.18 (p = 0.36). The duration of nCPAP was 16.4 (low-flow group) versus 41.1 days (nCPAP group), p < 0.001. There was no difference between groups in the fraction needing any respiratory support at 36 weeks' corrected age, length of stay, weight at discharge, and relative weight gain. Conclusions: Replacing nCPAP by low-flow O₂ in preterm infants with GA >26 weeks at the end of the first week of life did not seem to affect the a/A pO₂ ratio or weight gain negatively. Thus, prolonged nCPAP seems not to have a positive effect on lung function at 28 days of life and replacement by low-flow O₂ could reduce the cost of equipment and increase the ease of nursing.

Diaphragmatic activity during weaning from respiratory support in preterm infants

“…As a result, work of breathing (WOB) is often increased and gas exchange impaired 1. In an attempt to restore lung function and reduce WOB, preterm infants often receive respiratory support with nasal continuous positive airway pressure (nCPAP) and/or low flow nasal cannula (LFNC) as the most frequently used modes 2 3…”

Nasal High-Flow for Weaning Preterm Newborns with Risk of Chronic Lung Disease from nCPAP

“…However, our results differ from those described by Abdel-Hady et al 8 in 60 infants with a GA of !28 weeks who received CPAP 5 cm H 2 O with FiO 2 0.3 and who were weaned either from CPAP directly or by nasal cannula (2 lpm). In this study, the nasal cannula group spent more time on respiratory support and with supplemental oxygen (18 [11.5-29] days vs. 10.5 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days; p ¼ 0.003). It should be noted that the flow rate in this study was lower than in our study and the characteristics of the study population were different (mean GA 31 weeks and mean BW 1,600 g).…”

“…Parental perception of infant comfort was also significantly higher in the nHFT group (median 25 [23][24][25][26][27] vs. 20 [15][16][17][18][19][20][21][22][23]; p ¼ 0.0004) There were no differences in morbidities or related complications (►Table 2). There were no differences in the results between both approaches when patients were stratified according to gestational age.…”

Is humidified better than non‐humidified low‐flow oxygen therapy? A systematic review and meta‐analysis

“…Oxygen therapy is the administration of oxygen at higher concentrations than ambient air (20.9%) for combating hypoxia (Fulmer & Snider, ). Previous studies (Heiring, Steensberg, Bjerager, & Greisen, ; Ringbaek, Viskum, & Lange, ) have revealed that long‐term and low‐flow oxygen administration in some chronic diseases (such as chronic obstructive pulmonary disease) can not only improve hypoxia symptoms but also reduce the length of hospital stay and prolong life expectancy. Nasal cannulas are the most widely used tool for oxygen administration in hospital and community; the oxygen delivered by nasal cannulas may or may not be humidified by humidifier bottles.…”