High Flow Nasal Cannula Versus Nasal CPAP in the Management of Respiratory Distress Syndrome : Preliminary Data

BACKGROUND: High flow nasal cannula (HFNC) are gaining in popularity as a form of non invasive ventilation (NIV) alternative to nasal continuous positive airway pressure (NCPAP) in preterm infants. Despite of a greater ease of use and reports of improved tolerance, there is a limited evidence to support its efficacy and safety. OBJECTIVE: To assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with respiratory distress syndrome (RDS). DESIGN/METHODS: Preterm infants with gestational age (GA) between 29+0 and 36+6 weeks and radiological and clinical signs of moderate RDS were randomized to NCPAP (Infant Flow SIPAP- CareFusion) at 4-6 cmH2O or heated humidified HFNC (Precision Flow - Vapotherm) at 4-6 l/min. The primary outcome was the need of intubation within the first 72 hours of life. Secondary outcomes included: the need of surfactant, total duration of respiratory assistance and NIV, length of hospitalization and O2 supplementation, time to full enteral feeding and the incidence of the most common short and long term complications of prematurity (necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, bronchopulmonary dysplasia and retinopathy of prematurity). Continuous variables were analyzed by Student t test and categorical variables by Fisher's exact test. Statistical significance was considered for p<0.05. RESULTS: We enrolled 92 infants [NCPAP (n 52): GA 33±1.89 wks (mean±SD), BW 1895±487 g; HFNC (n 40): GA 33±1.83 wks, BW 1930±513 g]. The baseline characteristics and perinatal risk factors were similar between the two groups (p=NS). Despite the need of intubation within 72 hours was greater in HFNC group (12.5%, 5/40) compared to NCPAP group (5.7%, 3/52), the difference was not statistically significant (p=0.28). Differences in secondary outcomes were not observed; particularly mean duration of NIV was 5.8 days in HFNC group vs 4.3 in NCPAP group, mean total duration of respiratory assistance 6.4 days vs 4.7 and mean length of hospitalization 25.3 days vs 24.4 (p=NS). CONCLUSIONS: According to our preliminary data, HFNC seems as effective and safe as NCPAP in the management of moderate RDS in premature infants. Further trials are needed to validate the use of HFNC as a non invasive respiratory support in situations when NCPAP has traditionally been used