Abstract

Background: Preterm neonates with respiratory distress are usually managed by either non-invasive or invasive respiratory support. Among non-invasive respiratory supports, continuous positive airway pressure (CPAP) is used as the common modality of treatment in preterm neonates. Evidence for heated humidified high-flow nasal cannula (HHHFNC) as an alternative mode of non-invasive respiratory support is inconclusive.
Objective of the study: To compare the efficacy of heated humidified high-flow nasal cannula (HHHFNC) with continuous positive airway pressure (CPAP) as an initial non-invasive respiratory support in preterm neonates with respiratory distress.
Methodology: This randomized clinical trial was carried out on 56 inborn preterm neonates, in the Department of Neonatology, BSMMU, Dhaka from October 2020 to September 2021. Inborn preterm neonates with respiratory distress required non-invasive respiratory support were enrolled for the study. Out of 64 neonates, 8 neonates were excluded and finally 56 neonates were included for the study. After satisfying the inclusion criteria, computer-based randomization was done with 28 neonates in the HHHFNC group received HHHFNC support and another 28 neonates in the CPAP group received CPAP support after taking informed written consent from the parents/guardians. After initiation of assigned treatment, the incidence of treatment failure within 72 hours and also complications of both CPAP and HHHFNC groups were collected, analyzed and compared. All data were recorded in a preformed questionnaire and data were analyzed by statistical package for social sciences (SPSS) version 22. Quantitative variables were compared by unpaired t-test and categorical variables by Chi-square test/ Fisher’s exact test. p-value <0.05 was considered as significant.
Result: A total of 56 neonates were studied, the incidence of treatment failure within 72 hours was 10.7% and 14.3% in the HHHFNC and CPAP group respectively and was not statistically significant (P=1.00). Nasal trauma occurred 3.6% in the HHHFNC group in comparison to 28.6% in the CPAP group which was statistically significant (P=0.02).
Conclusion: HHHFNC is equally efficacious to nasal CPAP when applied as an initial mode of non-invasive respiratory support for respiratory distress in preterm neonates. Furthermore, HHHFNC is a safer modality than CPAP in terms of nasal trauma.

Keywords: Heated humidified high-flow nasal cannula; Nasal continuous positive airways pressure; Initial non-invasive respiratory support; Respiratory distress in preterm neonate