Heated, humidified high-flow nasal cannula vs. nasal CPAP in infants with moderate respiratory distress

Main Article Content

Adhi Teguh Perma Iskandar
Risma Kerina Kaban
Mulyadi M Djer

Abstract

Background Respiratory distress is the most common cause of morbidity in premature babies in the delivery room. Nasal continuous positive airway pressure (nCPAP) is widely used as the preferred modality of treatment, although it may cause nasal trauma. Heated, humidified high-flow nasal (HHHFN) cannula is an alternative oxygen therapy, yet the safety and efficacy has not been widely studied.


Objective To compare the safety and efficacy of HHHFN and nCPAP in premature babies with gestational age > 28 to < 35 weeks and moderate respiratory distress.


Methods We conducted a randomized, non-inferiority, clinical trial using HHHFN vs. nCPAP as a treatment for moderate respiratory distress within 72 hours after they had been used. The efficacy endpoints were treatment failure, length of device use, length of Kangaroo Mother Care (KMC), and full enteral feeding time. Safety assessment included pain score, nasal trauma, and systemic complications.


Results No differences were found in terms of incidence of endotracheal intubation within < 72 hours of HHHFN (20%) compared to nCPAP (18%) (P=0.799). However, there was a significant difference in moderate nasal trauma in nCPAP (14%) compared to HHHFN (0%)(P=0.006). There were no significant differences of blood gas analysis results, full enteral feeding time, length of KMC, length of device use, and rate of complications (bronchopulmonary dysplasia/BPD, intraventricular hemorrhage/IVH, patent ductus arteriosus/PDA, necrotizing enterocolitis/NEC and late onset neonatal sepsis/LONS) between the nCPAP and HHHFN groups.


Conclusion The HHHFN is not inferior to nCPAP in terms of the safety and efficacy as primary non-invasive therapy in premature babies of gestational age > 28 to < 35 weeks with moderate respiratory distress . Compared to nCPAP, HHHFN induced lower nasal trauma.

Article Details

How to Cite
1.
Perma Iskandar A, Kaban R, Djer M. Heated, humidified high-flow nasal cannula vs. nasal CPAP in infants with moderate respiratory distress. PI [Internet]. 11Dec.2019 [cited 27Sep.2020];59(6):331-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2203
Section
Neonatology
Author Biographies

Risma Kerina Kaban

Perinatology Division, Department of Child Health, University of Indonesia Medical School/Cipto Mangunkusumo Hospital

Mulyadi M Djer

Division of Cardiology, Department of Child Health, University of Indonesia Medical School/Cipto Mangunkusumo Hospital

Received 2019-05-17
Accepted 2019-12-06
Published 2019-12-11

References

1. Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010;31:487-95.
2. Ambalavanan N, Carlo WA. Assisted ventilation. In: Fanaroff AA, Fanarof JM, editors. Klaus & Fanaroff's care of the high risk neonate. 6th ed. New York: Elsevier Saunders. 2013. p. 271-5.
3. DiBlasi RM. Neonatal noninvasive ventilation techniques: do we really need to intubate? Respir Care. 2011;56:1273-94.
4. Wiswell TE, Courtney SE. Non-invasive respiratory support. In: Goldsmith JP, Karoktin EH, editors. Assisted ventilation of the neonate. 5th ed. New York: Saunders Elsevier. 2011. p. 140-50.
5. Davis PG, Morley CJ, Owen LS. Non-invasive respiratory support of preterm neonates with respiratory distress: continuous positive airway pressure and nasal intermittent positive pressure ventilation. Semin Fetal Neonatal Med. 2009;14:14-20.
6. Waterschoot T, Vercuysse R, Boutagef A, Coutteau M. Bubble CPAP: evaluation of complications. Early Hum Dev. 2009;85:95.
7. Wilkinson D, Andersen C, O'Donnel CP, De Paoli AG, Manley BJ. High flow nasal canula for respiratory support in preterm infants (review). Cochrane Database Syst Rev. 2016;2:CD006405.
8. Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, Abassi S. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics. 2013;131:1482-90.
9. Kotecha SJ, Adappa R, Gupta N, Watkins WJ, Kotecha S, Chakraborty M. Safety and efficacy of high flow nasal cannula therapy in preterm infants: a meta-analysis. Pediatrics. 2015;136:542-53.
10. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. The Journal of Pediatrics. 1991; 119:417–23.
11. Downes JJ, Vidyasagar D, Boggs TR, Morrow GM. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr (Phila). 1970;9:325-31.
12. Rusmawati A, Haksari EL, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. Paediatr Indones. 2008;48:342-5.
13. 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.
14. Iranpour R, Sadeghnia A, Hesaraki M. High flow nasal cannula versus nasal continuous positive airway pressure in the management of respiratory distress syndrome. J Isfahan Med School. 2011;29:761-71.
15. Roberts CT, Owen LS, Manley BJ, Froisland DH, Donath SM, Dalziel KM, et al. Nasal high flow therapy for primary respiratory support and preterm infants. N Engl J Med. 2016;375:1142-5.
16. Shin J, Park K, Lee EH, Choi BM. 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;32:650-5.
17. Ciuffini F, Pietrasanta C, Lavizzari A, Musumeci S, Gualdi C, Sortino S, et al. Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data. Pediatr Med Chir. 2014;36:88.
18. Manley BJ, Dold SK, Davis PG, Roehr CC. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology. 2012;102:300-8.
19. Edmond D, Lachance C, Gagnon J, Bard H. Arterial partial pressure of oxygen required to achieve 90% saturation of hemoglobin in very low birth weight newborns. Pediatrics. 1993;91:602-4.
20. Naik S, Greenough A, Giffin FJ, Baker A. Manoeuvres to elevate mean airway pressure, effects on blood gases and lung function in children with and without pulmonary pathology. Eur J Pediatr. 1998;157:309-12.
21. Goldstein RF. Developmental care for premature infants: a state of mind. Pediatrics. 2012;129:1322-3.
22. Hall RW, Anand KJ. Pain management in newborns. Clin Perinatol. 2014;41:895-924.
23. Klingenberg C, Pettersen M, Hansen EA, Gustavsen LJ, Dahl IA, Leknessund A, et al. Patient comfort during treatment with heated high flow nasal cannulae versus nasal continuous positive airway pressure: a randomised cross-over trial. Arch Dis Child Fetal Neonatal. 2014;99:134-7.
24. Sjarif DR, Rohsiswatmo R, Rundjan L, Yulianti C. Evidence-based guidance of nutritional care for premature babies. Jakarta: Departemen Ilmu Kesehatan Anak RSCM; 2015.p. 2-5.
25. King C. What’s new in enterally feeding the preterm infant? Arch Dis Child Fetal Neonatal Ed. 2010;95:304-8.
26. Glackin SJ, O’Sullivan A, George S, Semberova J, Miletin J. High flow nasal cannula versus NCPAP, duration to full oral feeds in preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2017;102:329-32.
27. Collins CL, Barfield C, Horne RSC, Davis PG. A comparison of nasal trauma in preterm infants extbated to either heated humidified high-flow nasal cannlae or nasal continuous positive airway pressure. Eur J Pediatr. 2014; 173:181-6.