Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in extremely low birth weight preterm infants after extubation: a single centre randomized controlled trial

Dhilli Ravindranath Gangu; Seshagiri Koripadu

doi:10.18203/2349-3291.ijcp20204404

Authors

Dhilli Ravindranath Gangu Department of Neonatology, OMNIRK Hospital Visakhapatnam, Andhra Pradesh
Seshagiri Koripadu Department of Neonatology, OMNIRK Hospital Visakhapatnam, Andhra Pradesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20204404

Keywords:

Extremely low birth weight infant, Non-invasive respiratory support extubation, Preterm, HHHFNC, NCPAP

Abstract

Background: The objective of the study was to assess the indications, frequency of usage, clinical efficacy, and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low birth weight preterm infants (ELBWI) after extubation.

Methods: Hospital based prospective randomized control study involving ELBWI with respiratory distress admitted in NICU. In this study, all selected preterm infants were placed on one of the non-invasive respiratory supports (HHHFNC or NCPAP), after a period of positive pressure ventilation (post-extubation). Reintubation rate within 72 hours after initial extubation, duration of invasive ventilation, duration of non-invasive respiratory support, duration of supplemental oxygen, and time to reach full feeds were the primary outcome measures. Duration of total enteral feeding, average weight gain rate, duration of hospitalization, and complications including nasal injury, IVH, BPD, NEC, ROP, and PDA, were the secondary outcomes.

Results: A sample size of 46 ELBWI were included. HHHFNC effectively reduced the incidence of nasal injury and NEC (p<0.05) along with the decreased duration of supplementary oxygen. Additionally, HHHFNC achieved a significant advance in time to reach full enteral feeding; increased the average weight gain before discharge; reduced the duration of hospitalization (p<0.05).

Conclusions: HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI compared to NCPAP. HHHFNC shortens the duration of supplemental oxygen and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the duration of hospitalization and its cost.

Metrics

Metrics Loading ...

Author Biographies

Dhilli Ravindranath Gangu, Department of Neonatology, OMNIRK Hospital Visakhapatnam, Andhra Pradesh

NNF fellow

MD pediatrics

Seshagiri Koripadu, Department of Neonatology, OMNIRK Hospital Visakhapatnam, Andhra Pradesh

CHIEF CONSULTANT

MD DM NEONATOLOGIST

Fellowship coordinator

References

Mathai SS, Raju U, Kanitkar M. Management of respiratory distress in the newborn. MJAFI. 2007;63:269-72.

Rubaltelli FF, Dani C, Reali MF, Bertini G, Weichmann L, Tangucci M, et al. Acute neonatal respiratory distress in Italy: a one-year prospective study, Acta Paediatr. 1998;87:1261-8.

NNPD working definitions. NNPD report 2002-2003. NNPD network, ICMR; p67. Available at: https://www.newbornwhocc.org/pdf/database.pdf. Accessed on 23 July 2020.

Berger J, Mehta P, Bucholz E, Dziura J, Bhandari V. Impact of early extubation and reintubation on the incidence of bronchopulmonary dysplasia in neonates. Am J Perinatol. 2014;31(12):1063-72.

Walsh MC, Morris BH, Wrage LA, Vohr BR, Poole WK, Tyson JE, et al. National Institutes of Child Health and Human Development Neonatal Research Network. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr. 2005;146 (6):798-804.

Garland JS. Strategies to prevent ventilator-associated pneumonia in neonates. Clin Perinatol. 2010;37(3):629-43.

Friedman CA, Menchaca RC, Baker MC, Rivas CK, Laberge RN, Rios EH, et al. Bubble nasal CPAP, early surfactant treatment, and rapid extubation are associated with decreased incidence of bronchopulmonary dysplasia in very-low-birth-weight newborns: efficacy and safety considerations. Respir Care. 2013;58:1134-42.

Verder H, Bohlin K, Kamper J, Lindwall R, Jonsson B. Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia. Acta Pediatr. 2009;98: 1400-8.

Walsh BK, Brooks TM, Grenier BM. Oxygen therapy in the neonatal care environment. Respir Care. 2009;54:1193-202.

Hough JL, Shearman AD, Jardine LA, Davies MW. Humidified high flow nasal cannula: current practice in Australasian nurseries, a survey. J Paediatr Child Health. 2012;48:106-13.

Hegde D, Mondkar J, Panchal H, Manerkar S, Jasani B, Kabra N. Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure as the primary mode of respiratory support for respiratory distress in preterm infants. Indian Pediatr. 2016;53:129-33.

Sekar K. The role of continuous positive airway pressure therapy in the management of respiratory distress in extremely premature infants. The journal of pediatric pharmacology and therapeutics. JPPT. 2006;11(3):145-52.

Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high ﬂow therapy: mechanisms of action. Respir Med. 2009;103:1400-5.

Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, et al. High flow nasal cannula in very preterm infants after extubation. N Engl J Med. 2013;369:1425-33.

Yoder BA, Stoddard RA, King J, Li M, Dirnberger DR, Abbasi S. Heated, humidiﬁed HFNC vs. nasal CPAP for respiratory support in neonates. Pediatrics. 2013;131:e1482-90.

Hong H, Li XX, Li J, Zhang ZQ. High-flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in preterm infants: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2019;2:1-8.

McCoskey L. Nursing care guidelines for prevention of nasal breakdown in neonates receiving nasal CPAP. Adv Neonatal Care. 2008;8(2):116-24.

Junior JC, Azevedo R, Araujo O, Carvalho WB. High flow nasal cannula as a post- extubation respiratory support strategy in preterm infants: a systematic review and meta- analysis. J Pediatr (Rio J). 2020;96 (4):422-31.

Collins CL, Barfield C, Horne RS, Davis PG. A comparison of nasal trauma in preterm infant’s extubated to either heated humidified high-flow nasal cannula or nasal continuous positive airway pressure. Eur J Pediatr. 2014;173:181-6.

Saslow JG, Aghai ZH, Nakhla TA, Hart JJ, Lawrysh R, Stahl GE, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol. 2006; 26:476-80.

Sreenan C, Lemke RP, Hudson-Mason A, Osiovich H. High-flow nasal cannula in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics. 2001;107:1081-3.

Lampland AL, Plumm B, Meyers PA, Worwa CT, Mammel MC. Observational study of humidified high-flow nasal cannula compared with nasal continuous positive airway pressure. J Pediatr. 2009;154(2):177-82.

Collins CL, Holberton JR, Barfield C, Davis PG. A randomized controlled trial to compare heated humidified high-flow nasal cannula with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr. 2013;162:949-54.

Osman M, Elsharkawy A, Abdel-Hady H. Assessment of pain during application of nasal continuous positive airway pressure and heated, humidified high-flow nasal cannula in preterm infants. J Perinatol. 2015;35:263-7.

Woodhead DD, Lambert DK, Clark JM, Christensen RD. Comparing two methods of delivering high-flow gas therapy by nasal cannula following endotracheal extubation: a prospective, randomized, masked, crossover trial. J Perinatol. 2006;26(8):481-5.

Jaile JC, Levin T, Wung JT, Abramson SJ, Shapiro CR, Berdon WE. Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors. AJR Am J Roentgenol. 1992;158:125-7.

Parish A, Bhatia J. Feeding strategies in the ELBW infant. J Perinatol. 2008;8:S18 -20.

Wilkinson D, Andersen C, O’ Donnell CPF, De Paoli AG, Manley BJ. High ﬂow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev. 2016;2:CD006405.