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

Abstract

Objective The aim of the study is to compare the duration of oxygen therapy by using two methods of weaning from nasal continuous positive airway pressure (nCPAP) in very preterm babies. Study Design Between April 2014 and December 2016, 90 preterm <32 weeks and birthweight >1,000 g who, after at least 7 days on nCPAP, were clinically stable on <6 cm H2O and FiO2 <30% were randomly assigned to weaning directly from nCPAP or with nasal high flow therapy (nHFT). In the nCPAP group, pressure was gradually reduced until the infant was stable on 4 cm H2O and then discontinued. In the nHFT group, flow rate was reduced until the infant was stable at 3.l pm and then discontinued. Results Eighty-four infants completed the study. There were no differences between the groups for the primary outcome, duration of oxygen therapy (median 33 [14–48] versus 28 [15–37] days; p = 0.17). The incidence of moderate-to-severe bronchopulmonary dysplasia was similar. Weaning time was shorter in the nCPAP group (p = 0.02), but the failure rate was slightly higher although non-significant. In the nHFT group, we observed better perception of patient comfort and a lower incidence of severe nasal injury. Conclusion Weaning by nHFT compared with weaning directly off nCPAP does not prolong duration of oxygen therapy. Rather, it is associated with better perceptions of infant comfort among parents and lower rates of severe nasal injury. Key Points

High Flow Nasal Cannula for Weaning Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis

“…After thoroughly examining the full texts of 42 records, 35 were further excluded for various reasons, including incorrect interventions ( n = 19), inappropriate study design ( n = 15), and irrelevant outcomes ( n = 1). Consequently, a total of 7 RCTs were included in the analysis (Cresi F, 2023 [ 11 ], Clements J, 2022 [ 5 ], Gregoraci Fernández A, 2021 [ 6 ], Soonsawad S, 2016 [ 12 ], Tang J, 2015 [ 13 ], Badiee Z, 2015 [ 14 ], and Abdel-Hady H, 2011 [ 7 ]). Included studies were conducted in Afghanistan, Australia, Egypt, Italy, New Zealand, Spain, and Thailand.…”

“…The meta-analysis incorporated five trials [6,7,[11][12][13] that provided data on the duration of respiratory support. The findings showed that using HFNC for weaning CPAP did not result in a statistically significant difference in the duration of respiratory support compared to weaning CPAP alone (MD (95% CI) in days 3.52 (−0.02, 7.05); 5 RCTs; participants = 488; I 2 = 29%).…”

“…Apart from any nasal trauma, no significant differences were observed in the secondary outcomes. The meta-analysis showed HFNC for weaning CPAP resulted in reduced nasal trauma compared to weaning CPAP HFNC for Weaning CPAP Support in Preterm Infants alone ((RR (95% CI) 0.61 (0.38, 0.99); 4 RCTs; participants = 335; I 2 = 0%) [5,6,12,13] (Table 2; Fig. 4).…”

“…Despite the increasing use of HFNC as a weaning strategy for CPAP, the available evidence remains limited and contradictory [5][6][7]. Few randomised controlled trials (RCTs) have shown encouraging outcomes, indicating that HFNC is effective and comparable to CPAP [5,6].…”

“…Despite the increasing use of HFNC as a weaning strategy for CPAP, the available evidence remains limited and contradictory [5][6][7]. Few randomised controlled trials (RCTs) have shown encouraging outcomes, indicating that HFNC is effective and comparable to CPAP [5,6]. However, others have raised concerns about possible lung derecruitment, inconsistent pressure delivery, and prolonged respiratory support duration associated with HFNC [7].…”