Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure as primary mode of respiratory support for respiratory distress in preterm infants

Objective To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support. Study Design Prospective observational cohort study Setting Tertiary care level III neonatal intensive care unit Participants 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth. Intervention Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula ( n =46) or Nasal Continuous Positive Airway Pressure ( n =42). Primary outcome Need for mechanical ventilation within 72 hrs of initiating support. Results Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD–0.74 (95% CI 0.34–1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) ( P = 0.004). Conclusion Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.