High-flow nasal cannulae in very preterm infants after extubation

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• High-flow nasal cannulae (HFNC) are increasingly used for noninvasive respiratory support in very preterm infants post-extubation.
• Limited data exist on the efficacy and safety of HFNC compared to nasal continuous positive airway pressure (CPAP) in this vulnerable population.

Purpose of the Study:

• To evaluate the noninferiority of HFNC compared to nasal CPAP for respiratory support in very preterm infants after extubation.
• To assess treatment failure rates and associated complications, including nasal trauma.

Main Methods:

• A multicenter, randomized, noninferiority trial involving 303 very preterm infants (<32 weeks gestational age).
• Infants were assigned to receive either HFNC (5-6 L/min) or nasal CPAP (7 cmH2O) post-extubation.
• The primary outcome was treatment failure within 7 days; noninferiority margin was 20 percentage points.

Main Results:

• HFNC was noninferior to nasal CPAP, with treatment failure in 34.2% of the HFNC group vs. 25.8% of the CPAP group (risk difference: 8.4 percentage points).
• The incidence of nasal trauma was significantly lower with HFNC (P=0.01).
• No significant differences were observed in serious adverse events or other complications between the groups.

Conclusions:

• HFNC demonstrates similar efficacy to nasal CPAP for respiratory support in very preterm infants post-extubation.
• Despite the primary outcome being close to the noninferiority margin, HFNC offers a potentially safer alternative due to reduced nasal trauma.