Nasal high flow treatment in preterm infants

Area of Science:

• Neonatal respiratory support
• Pediatric critical care
• Pulmonology

Background:

• Nasal High Flow (HF) is a non-invasive respiratory support method for preterm infants.
• HF offers potential benefits like reduced nasal trauma and improved infant comfort compared to continuous positive airway pressure (CPAP).
• HF is increasingly used in neonatal intensive care units.

Purpose of the Study:

• To compare the efficacy and safety of Nasal High Flow (HF) versus CPAP in preterm infants.
• To evaluate HF as primary support and post-extubation support.
• To assess risks of treatment failure, mechanical ventilation, and neonatal morbidities.

Main Methods:

• Review of recent clinical trials and meta-analyses comparing HF and CPAP.
• Analysis of outcomes including treatment failure, need for mechanical ventilation, and adverse events.
• Focus on infants born at ≥28 weeks' gestational age, with limited data for <28 weeks.

Main Results:

• Primary HF support may increase the risk of treatment failure compared to CPAP.
• Rescue CPAP for HF failure does not increase the risk of mechanical ventilation.
• Post-extubation HF shows similar outcomes to CPAP, but data for extremely preterm infants (<28 weeks GA) is limited, suggesting a high risk of HF failure.

Conclusions:

• HF is a suitable alternative for non-invasive support, offering advantages over CPAP for some infants.
• Clinical decisions on primary HF use should consider its benefits, surfactant strategy, and disease severity.
• More research is needed on HF in extremely preterm infants (<28 weeks GA).