Abstract
Background: Continuous positive airway pressure (CPAP) has become a preferred method of respiratory support to preterm infants, especially those with birth weights <1250 g. In a study by Sreenan et al, standard nasal cannula with flows up to 2.5 L/min were used in neonates <2.0 kg. This ‘high-flow' system was shown to deliver similar positive distending pressures compared to ventilator-generated nasal CPAP, and was effective in reducing apnea of prematurity. Since that publication, ‘high-flow' CPAP has become increasingly popular in our neonatal intensive care. Its use has been felt to minimize nasal irritation from conventional nasal prongs. Our usual method of CPAPdelivery is an infant flow system (IFS). The purpose of this study was to determine whether high-flow CPAP was as effective as IFS CPAP in neonates < 1250 g.
Methods: Preterm infants <1250 g were randomized following their first extubation to either high-flow or IFS CPAP. Those randomized to the high-flow had flow determined by the following equation: flow (L/min)=0.92+0.68x, where x=weight in kg (Sreenan et al, 2001). The primary outcome was re-intubation within 7 days. Secondary outcomes included post-extubation Fi02 and number of apneas and bradycardias over a 7 day period. Additional secondary outcomes included nasal damage, assessed by digital photography and our own grading system (I–mild, II–moderate, III–severe) at days 1, 7 and 30 post-extubation.
Results: To date 26 neonates have been enrolled, 13 were randomized to conventional IFS CPAP and 13 to high-flow CPAP. The groups were similar in birthweight, gestational age (GA), use of caffeine and age at extubation. Mean GA was 27.5 ±1.8 weeks and mean birthweight was 964 ±162 g. Mean post-extubation age for the high-flow group was 96 ±147 hrs (median 48 hrs, range 7.5–552 hrs) compared to 193 ±360 hrs for the IFS CPAP group (median 24 hrs, range 18–1224 hrs). 8 of 13 infants randomized to high-flow CPAP were re-intubated within 7 days compared to 3 of 13 infants in the IFS CPAP group (p=0.047). There was a trend to higher Fi02 post-extubation and higher number of apneas and bradycardias in the infants randomized to the high-flow CPAP, although the differences were not statistically different. There was no appreciable difference in the degree of nasal damage.
Conclusion: Neonates <1250 g extubated to high-flow CPAP were re-intubated at a higher rates compared to IFS CPAP. High-flow nasal cannula should not be used as an equivalent form of CPAP at this time.
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Campbell, D., Shah, P., Shah, V. et al. 47 High-Flow Nasal Cannula Cpap Versus Infant Flow Nasal Cpap in Newly-Extubated Neonates <1250G. Pediatr Res 56, 472 (2004). https://doi.org/10.1203/00006450-200409000-00070
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DOI: https://doi.org/10.1203/00006450-200409000-00070