Comparison of Treatment Outcomes of High-Flow Nasal Cannula and Nasal Continuous Positive Airway Pressure in Preterm Neonates with Respiratory Distress Syndrome in the NICU of Shahid Sadoughi Hospital in Yazd

Document Type : Original Article

Authors

Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: Neonatal respiratory distress syndrome (RDS) is a common and urgent condition in newborns, caused by a lack of surfactant production and secretion. This study aimed to compare two non-invasive methods, nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC), for managing RDS.
Methods: The study was conducted in the Neonatal Intensive Care Unit (NICU) of Shahid Sadoughi Hospital between 2020 and 2021 and included 49 premature neonates (with gestation ≤34 weeks and birth weight ≤2,000 g) diagnosed with RDS. The neonates were randomly assigned to either the HFNC group (n = 24) or the nCPAP group (n = 25).
Results: No significant differences in demographic features were observed between the two groups. The HFNC group had lower rates of intubation, shorter hospitalization duration, and less need for full nutritional support and oxygen therapy compared to the nCPAP group, but these differences were not statistically significant. Additionally, there were no significant differences in complications such as traumatic nasal injury, apnea, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), pneumothorax, pulmonary hemorrhage, and mortality between the two groups.
Conclusion: The results of this study suggest that both HFNC and nCPAP are equally effective in treating premature neonates with RDS, with no significant differences in clinical outcomes. Given the cost-effectiveness of HFNC, medical staff expertise, and equipment accessibility, this approach could be considered a viable alternative to nCPAP.

Keywords


Corresponding Author: Seyed Reza Mirjalili

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  1. Sett A, Noble EJ, Forster DE, Collins CL. Cerebral oxygenation is stable in preterm infants transitioning to heated humidified high-flow nasal cannula therapy. Acta Paediatr 2021; 110(7): 2059-64.
  2. Bacha LT, Hailu WB, Tesfaye Geta E. Clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College. SAGE Open Med 2022; 10: 20503121221146068.
  3. Yadav S, Lee B, Kamity R. Neonatal respiratory distress syndrome. Available from: https://medlineplus.gov/ency/article/001563.htm
  4. Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, et al. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study. Ital J Pediatr 2021; 47(1): 129.
  5. Liu H, Feng H, Zhang Y, Zhang L. Efficacy and safety of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in neonatal respiratory distress syndrome: a systematic review and meta-analysis. Transl Pediatr 2022; 11(7): 1242-50.
  6. Dargaville P, Kamlin CO, Orsini F, Wang X, Paoli AD De, Kutman HGK, et al. Effect of Minimally Invasive Surfactant Therapy vs Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome: The OPTIMIST-A Randomized Clinical Trial. JAMA 2021; 326(24): 2478-87.
  7. Lavizzari A, Colnaghi M, Ciuffini F, Veneroni C, Musumeci S, Cortinovis I, et al. Heated, Humidified High-Flow Nasal Cannula vs Nasal Continuous Positive Airway Pressure for Respiratory Distress Syndrome of Prematurity: A Randomized Clinical Noninferiority Trial. JAMA Pediatr 2016.
  8. Kalikkot Thekkeveedu R, El-Saie A, Prakash V, Katakam L, Shivanna B. Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies. J Clin Med 2022; 11(3): 557.
  9. Hascoet J-M, Deforge H, Demoulin S, Picaud J, Zupan V, Ligi I, et al. Outcomes at 7 Years of Age of Former Very Preterm Neonates with Repeated Surfactant Treatment for Prolonged Respiratory Distress in the Neonatal Period. J Clin Med 2023; 12(19): 6220.
  10. Mahmoud RA, Roehr CC, Schmalisch G. Current methods of non-invasive ventilatory support for neonates. Paediatr Respir Rev 2011; 12(3): 196-205.
  11. Ciuffini F, Pietrasanta C, Lavizzari A, Musumeci S, Gualdi C, Sortino S, et al. Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data. Pediatr Med Chir 2014; 36(4): 88.
  12. Dopper A, Steele M, Bogossian F, Hough J. High flow nasal cannula for respiratory support in term infants. Cochrane database Syst Rev 2023; 8(8): CD011010.
  13. Hong H, Li X xia, Li J, Zhang Z qun. High-flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in preterm infants: a meta-analysis of randomized controlled trials. J Matern Neonatal Med 2021; 34(2): 259-66.
  14. Zhou R, Xiong T, Tang J, Huang Y, Liu W, Zhu J, et al. High-flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP) vs nasal intermittent positive pressure ventilation as primary respiratory support in infants of ≥ 32 weeks gestational age (GA): study protocol for a three-arm multi-center ran. Trials 2023; 24(1): 647.
  15. Esmaeilnia Shirvani T, Nayeri FS, Shariat M, Nafas N, Mirjalili MR, Hosseini SN, et al. Continuous Positive airway pressure or high flow nasal cannula for respiratory distress syndrome: a randomized control trail among premature infants. Iranian Journal of Neonatology 2019; 11(4): 50-6.
  16. Yuan G, Liu H-L, Wu Z, Chen X. Evaluation of three non-invasive ventilation modes after extubation in the treatment of preterm infants with severe respiratory distress syndrome.
    J Perinatol 2022; 42(9):1238-43.
  17. Kostekci YE, Okulu E, Bakırarar B, Kraja E, Erdeve O, Atasay B, et al. Nasal continuous positive airway pressure vs. nasal intermittent positive pressure ventilation as initial treatment after birth in extremely preterm infants. Front Pediatr 2022; 10:870125.
  18. Luo K, Huang Y, Xiong T, Tang J. High-flow nasal cannula versus continuous positive airway pressure in primary respiratory support for preterm infants: A systematic review and meta-analysis. Front Pediatr 2022; 10:980024.
  19. Safa FB, Noorishadkam M, Lookzadeh MH, Mirjalili SR, Ekraminasab S. Budesonide and Surfactant Combination for Treatment of Respiratory Distress Syndrome in Preterm Neonates and Evaluation Outcomes. J Clin Neonatol 2023; 12(4): 135-41.
  20. Daya A, Lookzadeh MH, Noorishadkam M, Mirjalili SR, Ekraminasab S. The effect of the Iranian Surfactant (Beraksurf) in the treatment of respiratory distress syndrome in premature neonates. World J Peri Neonatol 2023; 6(1): 10-6.
  21. Vitaliti G, Vitaliti MC, Finocchiaro MC, Di Stefano VA, Pavone P, Matin N, et al. Randomized comparison of helmet CPAP versus high-flow nasal cannula oxygen in pediatric respiratory distress. Respir Care 2017; 62(8): 1036-42.
  22. Shoemaker MT, Pierce MR, Yoder BA, DiGeronimo RJ. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 2007; 27(2):85-91.
  23. Kadivar M, Mosayebi ZM, Razi N, Nariman SM, Sangsari R. High flow nasal cannulae versus nasal continuous positive airway pressure in neonates with respiratory distress syndrome managed with INSURE method: A Randomized Clinical Trial. Iran J Med Sci 2016; 41(6): 494-500.
  24. Yengkhom R, Suryawanshi P, Gupta B, Deshpande S. Heated Humidified High-Flow Nasal Cannula vs. Nasal Continuous Positive Airway Pressure for Post-extubation Respiratory Support in Preterm Infants: A Randomized Controlled Trial. J Trop Pediatr 2020; 67(1): fmaa082.
  25. Iranpour R, Armanian A, Abedi A, Farajzadegan Z. Nasal high-frequency oscillatory ventilation (nHFOV) versus nasal continuous positive airway pressure (NCPAP) as an initial therapy for respiratory distress syndrome (RDS) in preterm and near-term infants. BMJ Paediatr Open 2019; 3(1): e000443.
  26. Cresi F, Maggiora E, Borgione S, Spada E, Coscia A, Bertino E, et al. Enteral Nutrition Tolerance and Respiratory Support (ENTARES) study in preterm infants: study protocol for a randomized controlled trial. Trials 2019; 20(1): 67.
  27. Wang J, Zhang L, Cai N. A comparative study of the efficacy and safety of high-flow nasal cannula and nasal continuous positive airway pressure in neonatal respiratory distress syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101(15): e29109.