High-Flow Nasal Cannula Therapy Works Well in Preterm Infants

Susan London

August 17, 2015

High-flow nasal cannula therapy is as safe and efficacious as conventional modes of noninvasive ventilation (NIV) in preterm infants, according to a meta-analysis published online August 17 and in the September issue of Pediatrics. And it carries sharply lower odds of nasal trauma.

"We feel that our data provide evidence to consider [heated humidified high-flow nasal cannula therapy] as a mode of respiratory support in preterm infants by clinicians," write the investigators, led by Sarah J. Kotecha, BSc, SRD, from the Department of Child Health, Cardiff University, United Kingdom.

"Caution needs to be exercised in extreme preterm infants because of the paucity of published data," they add.

The investigators analyzed data from nine randomized or quasi-randomized trials among 1112 preterm infants (born at less than 37 weeks of gestation) that compared high-flow therapy with other modes of NIV. In all but one of those trials, the other mode of NIV was nasal continuous positive airway pressure.

Main results showed that high-flow therapy was as efficacious as other modes of NIV, with statistically indistinguishable odds of failure of therapy whether it was used as a primary mode of support after birth or after extubation from mechanical ventilation.

The findings were also similar when restricted to infants younger than 32 weeks of gestational age and younger than 28 weeks of gestational age, although data were limited for these groups.

In an analysis of time to failure, high-flow therapy was similarly efficacious at 3 and 7 days after trial entry.

Moreover, when it came to safety, the high-flow therapy and conventional therapy groups did not differ significantly with respect to the odds of mortality or the odds of pulmonary air leaks.

However, preterm infants supported on high-flow therapy had a significant 87% reduction in the odds of nasal trauma relative to counterparts supported on conventional modes of NIV.

When the researchers restricted their analysis to studies that had a low risk of bias, the main findings were essentially unchanged.

There were also no significant differences between groups with respect to a variety of secondary outcomes, such as total duration of respiratory support, length of stay on the neonatal unit, and bronchopulmonary dysplasia.

The investigators acknowledge that the definition of failure of therapy differed across studies.

"Future research needs to concentrate on the extreme preterm group of infants, who would benefit most from modes of NIV," they maintain. "Weaning of NIV is another area of practice that needs further research, as a recent review on weaning of [heated humidified high-flow nasal cannula therapy] in preterm infants was unable to identify any eligible studies on this subject."

The authors have disclosed no relevant financial relationships.

Pediatrics. 2015;136:542-553. Abstract

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