title: Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates.
abstract: OBJECTIVE
  Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the NICU. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (nCPAP) for noninvasive respiratory support in the NICU.
  
  
  METHODS
  Randomized, controlled, unblinded noncrossover trial in 432 infants ranging from 28 to 42 weeks' gestational age with planned nCPAP support, as either primary therapy or postextubation. The primary outcome was defined as a need for intubation within 72 hours of applied noninvasive therapy.
  
  
  RESULTS
  There was no difference in early failure for HHHFNC (23/212 [10.8%]) versus nCPAP (18/220 [8.2%]; P = .344), subsequent need for any intubation (32/212 [15.1%] vs 25/220 [11.4%]; P = .252), or in any of several adverse outcomes analyzed, including air leak. HHHFNC infants remained on the study mode significantly longer than nCPAP infants (median: 4 vs 2 days, respectively; P < .01), but there were no differences between study groups for days on supplemental oxygen (median: 10 vs 8 days), bronchopulmonary dysplasia (20% vs 16%), or discharge from the hospital on oxygen (19% vs 18%).
  
  
  CONCLUSIONS
  Among infants ≥28 weeks' gestational age, HHHFNC appears to have similar efficacy and safety to nCPAP when applied immediately postextubation or early as initial noninvasive support for respiratory dysfunction.
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84158-1289, USA. bradley.yoder@hsc.utah.edu
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Stoddard
authors.forename: Ma
authors.initials: M
authors.lastname: Li
authors.forename: Jerald
authors.initials: J
authors.lastname: King
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Dirnberger
authors.forename: Soraya
authors.initials: S
authors.lastname: Abbasi
mesh_terms: D002404:Catheterization; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation / Q000379:methods*; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods / Q000401:mortality; D010100:Oxygen / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: CPAP; NICU; high-flow nasal cannula; respiratory support