The Effectiveness of the Heated Humidified High Flow Nasal Cannula as an Initial Noninvasive .......

Aims: To compare the effectiveness and protection of a heated humidified high-flow nasal cannula as a noninvasive respiratory support for the initial management of respiratory distress in preterm infants weighing less than 1300 g at various flow rates (3 L/min and 6 L/min) on admission in preterm infants weighing less than 30 weeks gestation.

A randomised controlled trial was used in this study.

The study took place in the Neonatal Intensive Care Unit of Tanta University Hospitals' Pediatrics department over a one-year cycle, from December 2018 to December 2019.

Methodology: 30 preterm neonates, with gestational ages ranged between 30 to 36 weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min as an initial respiratory support. Primary outcomes included: the incidence of treatment failure of the HHHFNC at flow 3 L/min and 6 L/min, which will require n CPAP or NIMV, or will require intubation. Secondary outcomes included: rate of deaths at any time after randomization, the total duration of all types of oxygen support and incidence of neonatal morbidities such as nasal trauma, symptomatic patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH ≥ grade II), pneumothorax, pulmonary hemorrhage, retinopathy of prematurity (ROP), apnea, sepsis and necrotizing enterocolitis (NEC ≥ stage II).

The need for a higher flow rate of HHHFNC (n=11, 36.6 percent ), the need for n CPAP or NIMV after failure of a higher flow rate of HHHFNC (n=11, 36.6 percent ), the need for intubation & MV (n=1, 3.3 percent ), the incidence of nasal trauma (n=7, 23.3 percent ), BPD (n=0), IVH II (n=0), NEC II (n= (6-7). There were 11 out of 30 infants (36.6%) who failed, with no deaths or pulmonary haemorrhage.

Conclusion: In preterm infants with respiratory distress, HHHFNC use demonstrates comparable rates of efficacy to other types of noninvasive respiratory support for initial respiratory support, with less complications. At flow rates of 3 or 6 L/min, higher gestational age and birth weight resulted in better outcomes.

Please see the link :- https://www.journaljammr.com/index.php/JAMMR/article/view/30690