title: [High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates].
abstract: OBJECTIVE
  To determine whether the availability of heated humidified high-flow nasal cannula (HFNC) therapy was associated with a decrease in need for mechanical ventilation in neonates hospitalised with acute bronchiolitis.
  
  
  METHODS
  A combined retrospective and prospective (ambispective) cohort study was performed in a type II-B Neonatal Unit, including hospitalised neonates with acute bronchiolitis after the introduction of HFNC (HFNC-period; October 2011-April 2015). They were compared with a historical cohort prior to the availability of this technique (pre-HFNC; January 2008-May 2011). The need for mechanical ventilation between the two study groups was analysed. Clinical parameters and technique-related complications were evaluated in neonates treated with HFNC.
  
  
  RESULTS
  A total of 112 neonates were included, 56 after the introduction of HFNC and 56 from the period before the introduction of HFNC. None of patients in the HFNC-period required intubation, compared with 3.6% of the patients in the pre-HFNC group. The availability of HFNC resulted in a significant decrease in the need for non-invasive mechanical ventilation (30.4% vs 10.7%; P=.01), with a relative risk (RR) of .353 (95% CI; .150-.829), an absolute risk reduction (ARR) of 19.6% (95% CI; 5.13 - 34.2), yielding a NNT of 5. In the HFNC-period, 22 patients received high flow therapy, and 22.7% (95% CI; 7.8 to 45.4) required non-invasive ventilation. Treatment with HFNC was associated with a significant decrease in heart rate (P=.03), respiratory rate (P=.01), and an improvement in the Wood-Downes Férres score (P=.00). No adverse effects were observed.
  
  
  CONCLUSIONS
  The availability of HFNC reduces the need for non-invasive mechanical ventilation, allowing a safe and effective medical management of neonates with acute bronchiolitis.
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España. Electronic address: bermudezlorena@hotmail.com.
authors.forename: Lorena
authors.initials: L
authors.lastname: Bermúdez Barrezueta
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Nuria
authors.initials: N
authors.lastname: García Carbonell
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: López Montes
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Gómez Zafra
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Purificación
authors.initials: P
authors.lastname: Marín Reina
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Jana
authors.initials: J
authors.lastname: Herrmannova
authors.affiliation: Departamento de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Casero Soriano
mesh_terms: D000208:Acute Disease; D001988:Bronchiolitis / Q000628:therapy*; D000072601:Cannula; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Bronchiolitis; Bronquiolitis aguda; High flow nasal cannula oxygen therapy; Invasive mechanical ventilation; Neonates; Neonatos; Non-invasive mechanical ventilation; Oxigenoterapia de alto flujo; Ventilación mecánica invasiva; Ventilación mecánica no invasiva