Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants

Roberts, Calum T.; Owen, Louise; Manley, Brett J.; Frøisland, Dag Helge; Donath, Susan; Dalziel, Kim; Pritchard, M. A.; Cartwright, David; Collins, C; Malhotra, Atul; Davis, Peter G

doi:10.1056/nejmoa1603694

Cited by 186 publications

(208 citation statements)

References 21 publications

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“…Reflecting our results, in the recent trial by Roberts et al [15], treatment failure occurred in 71 of the 278 infants (25.5%) in the HFNC group and in 38 of the 286 infants (13.3%) in the CPAP group (risk difference, 12.3 percentage points, 95% CI 5.8–18.7, p < 0.001). Also, the risk difference of treatment failure was higher among infants with lower gestation (<32 weeks: 14.7%, 95% CI 4.8–24.7, vs. ≥32 weeks: 10.1%, 95% CI 2.2–18).…”

Section: Discussionsupporting

confidence: 84%

“…Rescue nCPAP was not used for infants with treatment failure in the HFNC group. Compared with our trial and that by Roberts et al [15], enrolment of more mature infants (mean gestation of 33 weeks), infants with the less severe lung disease (median FiO 2 at enrolment 0.23 to 0.25), and aggressive and excess use of surfactant in both groups may be the reasons for a similar efficacy between the HFNC and nCPAP groups in their study.…”

Section: Discussionsupporting

confidence: 43%

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High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial

et al. 2018

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Background: Nasal continuous positive airway pressure (nCPAP) is the standard noninvasive respiratory support for newborns with respiratory distress. Evidence for high-flow nasal cannula (HFNC) as an alternative mode of respiratory support is inconclusive. Objective: The aim of this work was to evaluate whether HFNC is not inferior to nCPAP in reducing the need for higher respiratory support in the first 72 h of life when applied as a noninvasive respiratory support mode for preterm neonates with respiratory distress. Methods: Preterm infants (gestation ≥28 weeks and birth weight ≥1,000 g) with respiratory distress were randomized to either HFNC or nCPAP in a non-inferiority trial. Failure of the support mode in the first 72 h after birth was the primary outcome. Infants failing HFNC were rescued either with nCPAP or mechanical ventilation, and those failing nCPAP received mechanical ventilation. Results: During the study period, 139 and 133 infants were randomized to the nCPAP and HFNC groups, respectively. The study was stopped after an interim analysis showed a significant difference (p < 0.001) in the primary outcome between the 2 groups. The treatment failure was significantly higher in the HFNC group (HFNC, n = 35, 26.3%, vs. CPAP, n = 11, 7.9%, risk difference 18.4 percentage points, 95% CI 9.7–27). Among the infants in the HFNC group who had treatment failure (n = 35), 32 were initially rescued with CPAP. The rate of mechanical ventilation in the first 3 and 7 days of life was similar between the 2 groups. Treatment failure was significantly higher in the HFNC group per protocol and also in the subgroups of infants with moderate (Silverman Anderson score, SAS ≤5) or severe respiratory distress (SAS score >5). Conclusions: When comparing HFNC to nCPAP as a primary noninvasive respiratory support in preterm infants with respiratory distress, HFNC is inferior to nCPAP in avoiding the need for a higher mode of respiratory support in the first 72 h of life.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 43%

High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial

et al. 2018

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“…Immediate wrapping in a polythene bag under a radiant warmer also reduces heat loss [53], and increasing the environmental temperature in the delivery room to around 26°C is also recommended for babies less than 28 weeks [33]. Heated, humidified oxygen delivered by high-flow nasal cannula (HFNC) has also been studied as a primary mode of respiratory support but was inferior to CPAP in terms of failure, with babies randomised to HFNC often needing rescue with CPAP to prevent intubation [54]. …”

Section: Delivery Room Stabilisationmentioning

confidence: 99%

“…Centres familiar with the use of HFNC argue that with experience it can be used for initial support even in some of the smallest babies [103, 104]. In the HIPSTER trial, HFNC was compared with CPAP as a primary mode of support in the delivery room for infants >28 weeks, but the trial was stopped early because more infants started on HFNC needed rescue with CPAP [54]. At present, CPAP remains the preferred initial method of non-invasive support.…”

Section: Non-invasive Respiratory Supportmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…This trend is present in anaesthesia where laryngeal masks are used more frequently, and in intensive care, where non--invasive ventilation methods are being widely adopted [1][2][3][4]. The reduction of intubation frequency is also seen among neonatal patients, where many forms of non-invasive respiratory support have become a standard [5,6]. As a result, physicians' experience in performing intubation may be reduced, especially among those working outside operating theatres.…”

mentioning

confidence: 99%

Postępowanie w niespodziewanych trudnych drogach oddechowych u dzieci — stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej, Sekcji Przyrządowego Udrażniania Dróg Oddechowych Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz Po

Walas¹,

Aleksandrowicz²,

Borszewska−Kornacka³

et al. 2017

Anaesthesiol Intensive Ther

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Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants

Cited by 186 publications

References 21 publications

High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial

High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Postępowanie w niespodziewanych trudnych drogach oddechowych u dzieci — stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej, Sekcji Przyrządowego Udrażniania Dróg Oddechowych Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz Po

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