title: High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants.
abstract: OBJECTIVE
  To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP).
  
  
  METHODS
  This is a retrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis.
  
  
  RESULTS
  A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035-1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group.
  
  
  CONCLUSIONS
  In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: tahad@email.chop.edu.
authors.forename: Dalal K
authors.initials: DK
authors.lastname: Taha
authors.affiliation: Alere Inc, Waltham, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kornhauser
authors.affiliation: Division of Neonatology, Department of Pediatrics, Nemours/Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Greenspan
authors.affiliation: Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Dysart
authors.affiliation: Division of Neonatology, Department of Pediatrics, Nemours/Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Zubair H
authors.initials: ZH
authors.lastname: Aghai
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology*; D045422:Continuous Positive Airway Pressure; D004363:Drug Utilization; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: bronchopulmonary dysplasia (BPD); continuous positive airway pressure (CPAP); extremely low birth weight (ELBW); high flow nasal cannula (HFNC)