title: Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay.
abstract: BACKGROUND
  Heated humidified high-flow nasal cannula (HFNC) is thought to be comparable with nasal CPAP. The effect of multimodality mid-level respiratory support use in the neonatal ICU is unknown. The objective of this work was to evaluate the effect of introducing HFNC on length of respiratory support and stay.
  
  
  METHODS
  A chart review was conducted on subjects at 24-32 weeks gestation requiring mid-level support (HFNC/nasal CPAP) 1 y before and after HFNC implementation. The 2 groups were compared for clinical and demographic data using t test or chi-square analysis. Further, multivariate linear and logistic regression was done to determine significant risk factors for outcomes controlling for covariates.
  
  
  RESULTS
  Eighty subjects were eligible in the pre-HFNC group, and 83 were eligible in the post-HFNC group. Subjects were similar in their baseline characteristics. In clinical outcomes, the post-HFNC group had higher rates of retinopathy of prematurity (P = .02) and a trend toward higher bronchopulmonary dysplasia rates (P = .063). The post-HFNC subjects had longer duration of mid-level support and were older at the time they were weaned to stable low-flow nasal cannula (P < .05). Although the length of respiratory support and stay and corrected gestational age at discharge were similar, those in the pre-HFNC period were more likely to be receiving full oral feeds and be discharged home versus being transferred to an intermediate care facility (P < .05).
  
  
  CONCLUSIONS
  HFNC introduction was significantly associated with a longer duration of mid-level respiratory support, decrease in oral feeding at discharge, increased retinopathy of prematurity rates, and higher use of intermediate care facilities, leading us to examine our noninvasive ventilation and weaning strategies.
authors.affiliation: University of Maryland School of Medicine, Department of Pediatrics, Baltimore Maryland. shoffman@peds.umaryland.edu.
authors.forename: Suma B
authors.initials: SB
authors.lastname: Hoffman
authors.affiliation: University of Maryland Medical Center, Baltimore Maryland.
authors.forename: Natalie
authors.initials: N
authors.lastname: Terrell
authors.affiliation: University of Maryland School of Medicine, Department of Pediatrics, Baltimore Maryland.
authors.forename: Colleen Hughes
authors.initials: CH
authors.lastname: Driscoll
authors.affiliation: University of Maryland School of Medicine, Department of Pediatrics, Baltimore Maryland.
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Davis
mesh_terms: D000072601:Cannula; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure; D004867:Equipment Design; D005260:Female; D005865:Gestational Age; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D006813:Humidity; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000295:instrumentation* / Q000379:methods; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation* / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: high-flow nasal cannula; nasal CPAP; neonate; respiratory distress syndrome