High-Flow Nasal Cannulae for Respiratory Support of Preterm Infants: A Review of the Evidence

Abstract

Background: High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) in a variety of clinical situations, including post-extubation support, primary therapy from birth and ‘weaning’ from NCPAP. Objectives: To present and discuss the available evidence for the use of HFNC in the preterm population. Methods: An internet-based literature search for relevant, original research articles (both randomised studies and not) on the use of HFNC in preterm infants was undertaken. Results: A total of 19 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size and varies according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but probably only at flow rates >2 litres/min. The efficacy and safety of HFNC in preterm infants remain to be determined. Conclusions: There is growing evidence of the feasibility of HFNC as an alternative to other forms of non-invasive ventilation in preterm infants. However, there remains uncertainty about the efficacy and safety of HFNC in this population. Until the results of larger randomised trials are known, widespread use of HFNC to treat preterm infants cannot be recommended.

The Objective Use of Pulse Oximetry to Predict Respiratory Support Transition in Preterm Infants: An Observational Pilot Study

“…However, large randomized trials have not been performed comparing efficacy of HFNC with that of nasal CPAP. 19 Because methods of weaning CPAP vary in clinical practice, several studies have evaluated alternative CPAP weaning protocols. [24][25][26][27] In a multi-center, randomized control trial comparing 3 CPAP weaning protocols, Todd et al 24 demonstrated that decreasing CPAP pressure rather than cycling time off CPAP is the most effective method for CPAP weaning.…”

“…[13][14][15][16][17] To reduce lung injury from mechanical ventilation, noninvasive modes of respiratory support, such as nasal CPAP and high-flow nasal cannula (HFNC), have been increasingly used. [18][19][20][21][22][23] However, there is no agreement on best practices for weaning these devices. [24][25][26][27] Noninvasive in-dicators demonstrating readiness for reducing respiratory support are lacking.…”

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

“…[14][15][16] Several clinical trials over the last decade have collected evidence of the use of HHHFNC in preterm infants, both as a primary mode of support at birth and after extubation from MV. We conducted a systematic review and metaanalysis to collect all published information, to be able to guide clinical practice.…”

Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data

“…L'evidenza dell'efficacia della HFNC nelle patologie respiratorie neonatali comunemente gestite con la NCPAP è tuttavia ancora limitata. 13 Benché l'utilizzo della terapia con HFNC si stia diffondendo nei reparti di terapia intensiva neonatale, solo un numero limitato di studi, per lo più osservazionali, è stato pubblicato in relazione al suo utilizzo nella gestione delle patologie respiratorie del neonato, in particolare del prematuro con distress respiratorio (14). Tali studi risultano, peraltro, molto eterogenei per caratteristiche demografiche e cliniche dei pazienti studiati, materiali e metodi utilizzati, obiettivi primari e secondari.…”