Respiratory support with heated humidified high flow nasal cannula in preterm infants

Area of Science:

• Neonatal respiratory support
• Pulmonology
• Pediatric critical care

Background:

• Bronchopulmonary dysplasia (BPD) incidence remains high, necessitating improved respiratory support strategies in preterm infants.
• Reducing ventilator-induced lung injury via early extubation and noninvasive ventilation (NIV) is crucial for BPD prevention.
• Heated, humidified, high flow nasal cannula (HHHFNC) is increasingly used as an NIV mode in neonatal intensive care units.

Approach:

• This review examines the current evidence on HHHFNC use in preterm infants.
• Compares HHHFNC to other NIV modes like nasal continuous positive airway pressure (nCPAP) and nasal intermittent positive pressure ventilation (NIPPV).
• Highlights the need for further research, particularly randomized controlled trials, on HHHFNC as initial respiratory support.

Key Points:

• HHHFNC offers technical ease of use and physician preference over other NIV modes.
• Studies indicate lower rates of nasal breakdown and neonatal complications with HHHFNC compared to nCPAP and NIPPV.
• Extubation failure rates are comparable between HHHFNC and nCPAP groups.

Conclusions:

• HHHFNC is an efficacious and safe NIV option for preterm infants.
• Current data are insufficient to establish HHHFNC as an NIV standard, especially for initial "after birth" support in extremely preterm infants.
• Large randomized controlled trials are required to define the role of HHHFNC in neonatal respiratory care standards.