Main Article Content
Aims: To compare the efficacy and safety of the HHHFNC as a post extubation respiratory support of preterm infants who were initially required endotracheal intubation and conventional mechanical ventilator after birth at different flow rates (3 L/min and 6 L/min).
Study Design: A Randomized controlled trial.
Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019.
Methodology: 30 preterm, with gestational age (30-36) weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min to prevent postextubation failure. Primary outcomes: the incidence of treatment failure of the HHHFNC at flow 3 and 6 L/min, which will require n CPAP or NIMV, or will require reintubation after successful extubation within 72 h. Secondary outcomes: rate of deaths within 72 hours post extubation, the total duration of all types of oxygen support, total duration of hospitalization and incidence of neonatal morbidities such as nasal trauma, BPD, symptomatic PDA, IVH ≥ grade II, pneumothorax, pulmonary hemorrhage, ROP, apnea, sepsis and NEC ≥ stage II.
Results: The incidence of need for higher flow rate of HHHFNC (n =17, 56.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n =16, 53.3%), the need for intubation & MV (n =7, 23.3%), the incidence of nasal trauma (n =9, 30%), BPD (n =9, 30%) , IVH ≥ II (n =7, 23.3%) , NEC ≥ II (n =0), pneumothorax ( n =5, 16.6%) , pulmonary haemorrhage (n =3, 10%), death (n =3, 10%), median duration of hospitalization in days =22.5 (17-28), median duration of all oxygen support in days = 18 (15-21), so the failure rate was 17 out of 30 (56.6%).
Conclusion: HHHFNC use is noninferior to other forms of noninvasive respiratory support in preterm infants for prevention of extubation failure. There were better outcomes of HHHFNC with higher gestational age and birth weight in preterm infants at either flow rates 3 or 6 L/min.
World Health Organization. The global burden of disease. LONDON, The Lancet; 2010.
Kültürsay N, Köroğlu ÖA, Kızılcan S, et al. Assessment of the awareness of prematurity and related problems. Pediatr Res. 2017;4(4):227-31.
Soon BT. The global action report on preterm birth. Geneva: World Health Organization; 2012.
Levene I, Tupedohe I, Thearle J. Respiratory disorders. In: Levene I, Tupedohe I, Thearle J, editors. Neonatal Medicine. 3rd ed: London: Blackwell Science Ltd. 2000;9:3-11.
Wambach J, Hamvas A. Respiratory distress syndrome in the neonate. In: Martin R, Fanaroff A, Walsh M, editors. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed: Philadelphia, PA: Elsevier Saunders; 2015.
Soonsawad S, Swatesutipun B, Limrungsikul A, et al. Heated humidified high-flow nasal cannula for prevention of extubation failure in preterm infants. Indian J Pediatr. 2017;84(4):262-6.
Pfister RH, Soll RF. Initial respiratory support of preterm infants: The role of CPAP, the INSURE method, and noninvasive ventilation. Clin Perinatol. 2012;39(3):459-81.
Garg S, Sinha S. Non-invasive ventilation in premature infants: Based on evidence or habit. J Clin Neonatol. 2013;2(4):155-9.
Manley BJ, Owen LS, Doyle LW, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med. 2013;369(15):1425-33.
Yoder BA, Stoddard RA, Li M, et al. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics. 2013;131(5):1482-90.
Wilkinson D, Andersen C, O'Donnell CP, et al. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev. 2016;2:006405.
Sreenan C, Lemke RP, Hudson-Mason A, et al. High-flow nasal cannulae in the management of apnea of prematurity: A comparison with conventional nasal continuous positive airway pressure. Pediatrics. 2001;107(5):1081-3.
Kugelman A, Riskin A, Said W, et al. A randomized pilot study comparing heated humidified high-flow nasal cannulae with NIPPV for RDS. Pediatr Pulmonol. 2015; 50(6):576-83.
Abdel-Hady H, Shouman B, Aly H. Early weaning from CPAP to high flow nasal cannula in preterm infants is associated with prolonged oxygen requirement: A randomized controlled trial. Early Hum Dev. 2011;87(3):205-8.
Sasi A, Malhotra A. High flow nasal cannula for continuous positive airway pressure weaning in preterm neonates: A single-centre experience. J Paediatr Child Health. 2015;51(2):199-203.
Schlapbach LJ, Schaefer J, Brady AM, et al. High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive Care Med. 2014;40(4):592-9.
Reynolds P, Leontiadi S, Lawson T, et al. Stabilisation of premature infants in the delivery room with nasal high flow. Arch Dis Child Fetal Neonatal Ed. 2016; 101(4):284-7.
Boyle M, Chaudhary R, Kent S, et al. High-flow nasal cannula on transport: moving with the times. Acta Paediatr. 2014; 103(5):181-4.
Park K, Choi B, Shin J, et al. Humidified high flow nasal cannula in preterm infants. Int J Technol Assess Health Care. 2017; 32(4):650.
Shin J, Park K, Lee EH, et al. Humidified high flow nasal cannula versus nasal continuous positive airway pressure as an initial respiratory support in preterm infants with respiratory distress: A Randomized, Controlled Non-Inferiority Trial. J Korean Med Sci. 2017;32(4):650-5.
Razak A, Charki S, Nagesh NK. High-flow nasal cannula versus cpap for respiratory support in preterm infants. Journal of Neonatology. 2015;29(3):11-15.
Taha DK, Kornhauser M, Greenspan JS, et al. High flow nasal cannula use is associated with increased morbidity and length of hospitalization in extremely low birth weight infants. J Pediatr. 2016;173: 50-5.
Mostafa-Gharehbaghi M, Mojabi H. Comparing the effectiveness of nasal continuous positive airway pressure (NCPAP) and high flow nasal cannula (HFNC) in prevention of post extubation assisted ventilation. Zahedan J Res Med Sci. 2015;17(6):984-9.
Akbarian-rad Z, Mohammadi A, Khafri S, et al. Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure after surfactant administration in preterm neonates with respiratory distress syndrome. Clin Respir J. 2020; 00:1–8.
Collins CL, Holberton JR, König K. Comparison of the pharyngeal pressure provided by two heated, humidified high-flow nasal cannulae devices in premature infants. J Paediatr Child Health. 2013; 49(7):554-6.