High-Flow Nasal Cannulae in Very Preterm Infants after Extubation

Abstract

Although the result for the primary outcome was close to the margin of noninferiority, the efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation. (Funded by the National Health and Medical Research Council; Australian New Zealand Clinical Trials Network number, ACTRN12610000166077.).

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

“…One study 21 revealed outcomes as medians and interquartile ranges. Means and SDs were calculated from this data by using methods published previously.…”

“…All of the studies involved preterm infants who were ,37 weeks' gestation, but 2 studies only included infants born at ,32 weeks' gestation. 21,27 One study included both term and preterm infants, but stratified data for the preterm infants were supplied by the authors. 38 Two studies compared HHHFNC with nCPAP both as a primary mode of respiratory support and as support after extubation from MV.…”

“…38 Thus, the final analysis included 6 studies where HHHFNC was compared with other forms of NIV as a primary mode of respiratory support 29,33,38,40,44,45 and 3 studies where these 2 modalities were compared after extubation from MV. 21,27,33 One study compared the 2 modes while weaning from respiratory support. 24 One study was only published as an abstract in English, but as full-text article in Persian.…”

Paediatrics in Barcelona

“…In a multicentre study, designed as a noninferiority trial, 303 infants were randomised post-extubation to either HFNC or nasal CPAP [122]. The primary outcome measure was treatment failure within 7 days; HFNC was close to the non-inferiority margin, but almost half of the infants in whom HFNC treatment failed could be successfully rescued with CPAP without reintubation.…”

Admission to NICU in air is more likely if nasal High Flow is used for stabilisation in preterm babies compared to face mask CPAP

“…Whilst the latest guidance supports the use of nasal Continuous Positive Airway Pressure (CPAP), (1,2) with evidence of improved outcomes compared with routine invasive respiratory support, (3,4) we recently demonstrated the feasibility of the use of nasal high flow (nHF) in the stabilisation of premature babies (23 to 29+6 weeks gestation) in the delivery room prior to transfer to Neonatal Intensive Care Unit (NICU). (5) Although several large studies have previously demonstrated that nHF is generally as effective as nCPAP for postextubation support, (6)(7)(8) there remains a paucity of literature on the use of nHF in the DR. Our previous study showed that stabilisation on nHF reduced the rate of DR intubation and surfactant administration compared to our prior practice. However our work was biased due to the requirement for consent to be obtained prior to delivery, which probably selected a "healthier" population of babies due to the time available for antenatal preparation with steroids, magnesium and interventions for optimal maternal health and delivery.…”