Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5—year retrospective analysis

Abstract

Aim This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR). Method This was a retrospective observational cohort study in a single‐centre neonatal intensive care unit and included all neonates born before 32 weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72 h of birth, bronchopulmonary dysplasia (BPD) and death. Results There were 491 eligible babies during the 5‐year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO2 at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self‐ventilating in air (SVIA) or receiving low‐flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7 days. At 36 weeks postmenstrual age, 36% of survivors had BPD. Conclusion We have demonstrated that preterm babies <32 weeks can be effectively stabilised on HF in the DR.

State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes

“…Neonatologists have applied nHFT after extubation, 72,73 as primary mode for treating respiratory distress, 56,72,74 preventing apnea of prematurity, 75 weaning from other support modes 76 and even as a tool for respiratory stabilization in the delivery room, 77 to support endotracheal intubation, 78 during transport 79 and in nontertiary centers 80 . However, only a few trials included a small number of infants <28 weeks' gestation 73,81,82 .…”

Guidelines for high‐flow nasal cannula oxygen therapy in neonates (2022)

“…Furthermore, it found that 59% of very preterm infants (n = 292) were stable under HFNC, and HFNC stabilization rates were higher in this group (gestational age of 27−32 weeks) compared with extremely preterm infants (63% vs. 53%, p = 0.036). 99 Therefore, the risk of HFNC therapy for extremely preterm infants was supposed to be higher.…”

“…For extremely preterm infants, there may be risks in the use of HFNC in the delivery room after birth. 99 Therefore, it is recommended that preterm infants born at ≥28 weeks of gestation can use HFNC for delivery room stabilization and transfer.…”

“…Evidence summary : Three studies were included in this recommendation, including one observational study 97 and two retrospective studies 98–99 . The observational study ( n = 28) found that 90% of preterm infants (gestational age ≤30 weeks) could be successfully stabilized with HFNC in the delivery room and transfer to the NICU using HFNC 97 .…”

“…Evidence summary: Three studies were included in this recommendation, including one observational study 97 and two retrospective studies. [98][99] The observational study (n = 28) found that 90% of preterm infants (gestational age ≤30 weeks) could be successfully stabilized with HFNC in the delivery room and transfer to the NICU using HFNC. 97 A retrospective study (n = 133) used HFNC to stabilize preterm infants (gestational age < 32 weeks) in the delivery room and found that 41% of the very preterm infants (n = 54) could be stabilized with HFNC.…”