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Chronic lung disease in preterm infants receiving various modes of noninvasive ventilation at ≤30 weeks'

Sandra L Leibel1,2, Xiang Y Ye3, Prakesh Shah1,3,4

  • 1Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|September 5, 2018
PubMed

Insights

Transitioning premature infants (born <29 weeks gestational age) to heated humidified high flow nasal cannula (HHHFNC) by 30 weeks postmenstrual age reduced chronic lung disease (CLD) risk compared to continuous positive airway pressure/nasal intermittent positive pressure ventilation (CPAP/NIPPV).

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Chronic lung disease (CLD) is a significant complication in extremely preterm infants.
  • Noninvasive respiratory support strategies after extubation are crucial for managing CLD risk.

Purpose of the Study:

  • To compare the incidence of CLD in mechanically ventilated infants born <29 weeks gestational age (GA) based on their noninvasive respiratory support at ≤30 weeks postmenstrual age (PMA).
  • To evaluate the association of different noninvasive ventilation strategies with CLD development.

Main Methods:

  • Retrospective cohort study of 2378 infants born <29 weeks GA across Canadian NICUs (2011-2015).
  • Infants were categorized into three groups based on respiratory support at ≤30 weeks PMA: CPAP/NIPPV alone, HHHFNC alone, or a combination.
  • Statistical analysis adjusted for potential confounders.

Main Results:

  • Infants receiving CPAP/NIPPV alone (OR 2.37) or a combination (OR 3.47) had significantly higher odds of developing CLD compared to those on HHHFNC alone.
  • Heated humidified high flow nasal cannula (HHHFNC) alone was associated with lower CLD incidence.

Conclusions:

  • Transitioning to HHHFNC by ≤30 weeks PMA is associated with a lower incidence of CLD in extremely preterm infants.
  • HHHFNC may be a beneficial alternative to prolonged CPAP/NIPPV or combination therapy for reducing CLD risk.

Keywords:
Chronic lung diseasecontinuous positive airway pressure (CPAP)heated humidified high flow nasal cannula (HHHFNC)mechanical ventilationpreterm

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