Efficacy and Safety of Two Different Flow Rates of Nasal High-Flow Therapy in Preterm Neonates ≥28 Weeks of Gestation: A Randomized Controlled Trial

Abstract

Objective The study aimed to compare the efficacy and safety of two different nasal high-flow rates for primary respiratory support in preterm neonates

Study Design In this single-center, double-blinded randomized controlled trial, preterm neonates ≥28 weeks of gestation with respiratory distress from birth were randomized to treatment with either increased nasal flow therapy (8–10 L/min) or standard nasal flow therapy (5–7 L/min). The primary outcome of nasal high-flow therapy failure was a composite outcome defined as the need for higher respiratory support (continuous positive airway pressure [CPAP] or mechanical ventilation) or surfactant therapy.

Results A total of 212 neonates were enrolled. Nasal high-flow failure rate in the increased flow group was similar to the standard flow group (22 vs. 29%, relative risk = 0.81 [95% confidence interval: 0.57–1.15]). However, nasal flow rate escalation was significantly more common in the standard flow group (64 vs. 43%, p = 0.004). None of the infants in the increased flow group developed air leak syndromes.

Conclusion Higher nasal flow rate (8–10 L/min) when compared with lower nasal flow rate of 5 to 7 L/min did not reduce the need for higher respiratory support (CPAP/mechanical ventilation) or surfactant therapy in moderately and late preterm neonates. However, initial flow rates of 5 L/min were not optimal for most preterm infants receiving primary nasal flow therapy.

Key Points

• Use of high nasal flows (8–10 L/min) did not reduce the need for higher respiratory support in moderately and late preterm infants.

• Nasal flow rate of 5 L/min was not optimal for most preterms with respiratory distress from birth.

• Careful patient selection and optimized flow settings could enhance nasal flow success in neonates.

Keywords

nasal high flow - continuous positive airway pressure - respiratory distress - neonate

Authors' Contributions

H.B. conceptualized the study and drafted the initial manuscript. S.S. and S.M. collected the data and performed the initial analysis. L.S. and N.K. conducted literature search, supervised the study conduct, and critically reviewed the manuscript. B.G. and J.A. were involved in patient screening and enrollment and contributed to data analysis. Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

Publication History

Received: 01 November 2020

Accepted: 01 February 2021

Article published online:
23 March 2021

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