High-flow nasal cannula versus continuous positive airway pressure in primary respiratory support for preterm infants: A systematic review and meta-analysis

Abstract

Respiratory support is crucial for the survival of preterm infants, and High-flow Nasal Cannula Oxygen Therapy (HFNC) and Continuous Positive Airway Pressure (CPAP) are commonly used for neonatal respiratory support. This meta-analysis aimed to compare the effects of HFNC and CPAP in primary respiratory support for preterm infants, to provide evidence-based support for clinical practice. PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, VIP, WANFANG and SinoMed were searched for eligible studies. The primary outcomes included the incidence of treatment failure and the application of mechanical ventilation. A total of 27 eligible studies with 3,351 participants were included. There was no significant difference in the incidence of respiratory support failure [RR = 1.17, 95%CI (0.88–1.56)] and the application of mechanical ventilation [RR = 1.00, 95%CI (0.84–1.19)] between HFNC group and CPAP group. HFNC resulted in lower rate of air leaks [RR = 0.65, 95%CI (0.46–0.92)], nasal trauma [RR = 0.36, 95%CI (0.29–0.45)] and abdominal distension [RR = 0.39, 95%CI (0.27–0.58)], and later time of mechanical ventilation initiating [SMD = 0.60, 95%CI (0.21–0.99)], less duration of oxygen therapy [SMD = −0.35, 95%CI (−0.68 to −0.02)] and earlier enteral feeding [SMD = −0.54, 95%CI (−0.95 to −0.13)]. Alternative non-invasive respiratory support after initial treatment failure resulted in no difference in the application of mechanical ventilation between the two groups [RR = 0.99, 95%CI (0.52–1.88)]. HFNC might be more effective and safer in primary respiratory support for preterm infants. Using CPAP as a remedy for the treatment failure of HFNC could not avoid intubation. For premature infants with the gestational age <28 weeks, HFNC as primary respiratory support still needs to be further elucidated.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022313479, identifier: CRD42022313479.

Effect of Nasal Continuous Positive Airway Pressure vs Heated Humidified High-Flow Nasal Cannula on Feeding Intolerance in Preterm Infants With Respiratory Distress Syndrome

“…However, that study is not comparable with the present trial since the occurrence of NEC was 5- to 10-fold higher and the antenatal corticosteroids rate was 4- to 5-fold lower . A recent meta-analysis supports this hypothesis, reporting that earlier FEF was reached with HHHFNC compared with NCPAP as the primary respiratory support . However, the authors emphasized the high heterogeneity of the results, suggesting that results might be affected by the lack of protocols and other undetected bias.…”

“…Some studies comparing NCPAP and HHHFNC have reported data on their possible effects on enteral nutrition. Although these data were conflicting, a recent meta-analysis suggested the benefits of HHHFNC vs NCPAP for feeding tolerance . Despite the effects of different types of NRS on nutrition and growth of very preterm infants, no randomized clinical trial has been specifically conducted to assess such outcomes.…”

Effect of Nasal Continuous Positive Airway Pressure on Retinopathy of Prematurity in Preterm Newborns: A Comparative Analysis with Mechanical Ventilation and High-Flow Nasal Cannula Therapy

“…While in the literature, MV and HFNC are the therapies most commonly associated with ROP [ 7 , 8 , 14 , 44 , 45 ], in our study it was the less reputed ROP risk factor, namely nCPAP, that had the strongest correlation with ROP incidence, while MV and HFNC were not significant risk factors at any level of analysis. This is especially surprising following the results of a recent systematic review, in which the pooled results of a meta-analysis of 3 studies comparing nCPAP and HFNC in terms of risk of ROP were not statistically significant [ 46 ].…”

Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside

“…Recently, a systematic review and meta-analysis has been published with the aim to compare HFNC versus nCPAP as primary respiratory support in preterm infants to provide evidence-based support for clinical practice [ 46 ]. The primary outcome considered was the incidence of treatment failure and the need for MV after non-invasive respiratory support.…”