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High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study

Journal of Perinatology volume 27, pages 85–91 (2007)Cite this article

Abstract

Objective:

Our objective is to assess the frequency of usage, safety and clinical utility of humidified high flow nasal cannula (HHFNC) in two tertiary care hospitals and compare outcomes to a historical control group of premature infants who received nasal continuous positive airway pressure (NCPAP).

Study design:

The first part of the study describes the increased HHFNC usage in two tertiary neonatal intensive care units. The second part compares outcomes of infants, born at less than 30 weeks gestation, who received either NCPAP or HHFNC as an early respiratory support mode.

Results:

HHFNC usage increased (64%) after its introduction in infants of all gestational ages whereas the usage of NCPAP decreased from 19 to 4%. Ninety-five percent of infants born at less than 30 weeks gestation received HHFNC at some point during their hospital stay whereas only 12% received NCPAP. There were no differences in death or bronchopulmonary dysplasia (BPD), but ventilator-days per patient were decreased (19.4 to 9.9) following introduction of HHFNC. Comparing the cohort of infants who received either NCPAP or HHFNC as an early mode of respiratory support, there were no differences in deaths, ventilator-days, BPD, blood infections or other outcomes. More infants were intubated for failing early NCPAP compared to early HHFNC (40 to 18%).

Conclusions:

HHFNC was well-tolerated by premature infants. Compared to infants managed with NCPAP, there were no apparent differences in adverse outcomes following the introduction of HHFNC. Additional research is needed to better define the utility and safety of HHFNC compared to NCPAP.

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References

  1. Angus DC, Linde-Zwirble WT, Clermont G, Griffen MF, Clark RH . Epidemiology of neonatal respiratory failure in the United States. Am J Resp Crit Care Med 2001; 164: 1154–1161.

    Article  CAS  PubMed  Google Scholar 

  2. Hudson LD . Progress in understanding ventilator-induced lung injury. JAMA 1999; 282: 77–78.

    Article  CAS  PubMed  Google Scholar 

  3. Jobe AH, Ikegami M . Mechanisms initiating lung injury in the preterm infant. Early Hum Dev 1998; 53: 81–94.

    Article  CAS  PubMed  Google Scholar 

  4. Rich W, Finer NN, Vaucher YE . Ten-year trends in neonatal assisted ventilation of very low- birthweight infants. J Perinatol 2003; 28: 660–663.

    Article  Google Scholar 

  5. Jegatheesan P, Keller RL, Hawgood S . Early variable-flow nasal continuous positive pressure in infants < or=1000 grams at birth. J Perinatol 2006; 26: 189–196.

    Article  CAS  PubMed  Google Scholar 

  6. Aly H, Milner JD, Patel K, El-Mohandes AA . Does the experience with the use of nasal continuous positive airway pressure improve over time in extremely low birth weight infants? Pediatrics 2004; 114: 697–702.

    Article  PubMed  Google Scholar 

  7. Narendran V, Donovan EF, Hoath SB, Akinbi HT, Steichen JJ, Jobe AH . Early bubble CPAP and outcomes in ELBW preterm infants. J Perinatol 2003; 23: 195–199.

    Article  PubMed  Google Scholar 

  8. Davis PG, Henderson-Smart DJ . Post-extubation prophylactic nasal continuous positive airway pressure in preterm infants: systematic review and meta-analysis. J Paediatr Child Health 1999; 35: 367–371.

    Article  PubMed  Google Scholar 

  9. Nair G, Karna P . Comparison of the effects of Vapotherm and nasal CPAP in respiratory distress in preterm infants. Pediatr Acad Soc 2005; 57: 2054.

    Google Scholar 

  10. Ovalle OO, Gomez T, Troncoso G, Palacios J, Ortiz E . High flow nasal cannula after surfactant treatment for infant respiratory distress syndrome in preterm infants <30 weeks. Pediatr Acad Soc 2005; 57: 3417.

    Google Scholar 

  11. Ramanathan A, Cayabyab R, Sardesai S, Siassi B, Seri I, Ramanathan R . High flow nasal cannula use in preterm and term newborns admitted to neonatal intensive care unit: A prospective, observational study. Pediatr Acad Soc 2005; 57: 3424.

    Google Scholar 

  12. Sanchez F, Sabato K . Very high nasal cannula-alternative to NCPAP in select ICN patients? Respir Care 2004; 49: 1373.

    Google Scholar 

  13. Holleman-Duray DL, Kaupie DL, Weiss MG . Safety and efficacy of the Vapotherm® high flow humidification system and an early extubation protocol. Pediatr Acad Soc 2006; 59: 517.

    Google Scholar 

  14. Sreenan C, Lemke RP, Hudson-Mason A, Osiovich H . High-flow nasal cannulae in management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 2001; 107: 1081–1083.

    Article  CAS  PubMed  Google Scholar 

  15. Chang GC, Cox CC, Shaffer TH . Nasal cannula, CPAP, and Vapotherm: effect of flow on temperature, humidity, pressure and resistance. Pediatr Acad Soc 2005; 57: 1231.

    Google Scholar 

  16. Courtney SE, Pyon KH, Saslow JG, Arnold GK, Pandit PB, Habib RH . Lung recruitment and breathing pattern during variable versus continuous flow nasal continuous positive airway pressure in premature infants: an evaluation of three devices. Pediatrics 2001; 107: 304–308.

    Article  CAS  PubMed  Google Scholar 

  17. Finer NN . Nasal cannula use in the preterm infant: oxygen or pressure? Pediatrics 2005; 116: 1216–1217.

    Article  PubMed  Google Scholar 

  18. Walsh M, Engle W, Laptook A, Kazzi SNJ, Buchter S, Rasmussen M et al. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved? Pediatrics 2005; 116: 857–861.

    Article  PubMed  Google Scholar 

  19. 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: 476–480.

    Article  CAS  PubMed  Google Scholar 

  20. Locke RG, Wolfson MR, Shaffer TH, Rubenstein SD, Greenspan JS . Inadvertent administration of positive end-distending pressure during nasal cannula flow. Pediatrics 1993; 91: 135–138.

    CAS  PubMed  Google Scholar 

  21. Kubicka Z, Limauro J, Darnall R . High flow nasal cannula therapy with Vapothem: yet another way to deliver CPAP? Pediatr Acad Soc 2006; 59: 5660.344.

    Google Scholar 

  22. Center for Disease Control Convention. Ralstonia associated with Vapotherm oxygen delivery device – United States, 2005. Morb Mortal Wkly Rep 2005; 54: 1052–1053.

  23. Graham III PL, Begg MD, Larson E, Della-Latta P, Allen A, Saiman L . Risk Factors for late onset Gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J 2006; 25: 113–117.

    Article  PubMed  Google Scholar 

  24. Woodhead DD, Lambert DK, Clark JM, Christensen RD . Comparing two methods of delivering high-flow gas therapy by nasal cannula following endotracheal extubation: a prospective, randomized, masked, crossover trial. J Perinatol 2006; 26: 481–485.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The opinions expressed are of the authors only and do not necessarily represent those of the Department of the Air Force or the Department of Defense.

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Authors and Affiliations

  1. Wilford Hall USAF Medical Center, Lackland AFB, TX, USA

    M T Shoemaker & R J DiGeronimo

  2. Pediatrix Medical Group, Santa Rosa Children's Hospital, San Antonio, TX, USA

    M R Pierce

  3. Primary Children's Medical Center, University of Utah, Salt Lake City, UT, USA

    B A Yoder

Authors
  1. M T Shoemaker
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  2. M R Pierce
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  3. B A Yoder
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  4. R J DiGeronimo
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Correspondence to M T Shoemaker.

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Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp)

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Shoemaker, M., Pierce, M., Yoder, B. et al. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 27, 85–91 (2007). https://doi.org/10.1038/sj.jp.7211647

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