PhD-candidate Emma Children's Hospital, Amsterdam UMC Amsterdam, Noord-Holland, Netherlands
Background: High flow nasal cannula (HFNC) has emerged in neonatal care to overcome the disadvantages of nasal continuous positive airway pressure (nCPAP), such as discomfort and nasal trauma. In many centers, nCPAP is still the preferred initial mode of respiratory support post-delivery in preterm infants, but during the first week(s) of life many infants are transitioned from nCPAP to HFNC. The long-term effects of HFNC after a stabilization period with nCPAP on lung growth have not yet been studied. Objective: This study investigated the impact of HFNC implementation on body weight and length as a proxy for lung growth at six months corrected age (CA) in preterm infants. Design/Methods: This population based retrospective cohort study included infants born at < 30 weeks gestational age (GA), admitted < 24 hours after birth to the neonatal intensive care unit of the Amsterdam UMC between 2009-2018, and surviving to six months CA. Two epochs were formed; the nCPAP cohort consisted of preterm infants born between 2009-2012 only treated with nCPAP and weaned to low flow nasal cannula (LFNC), and the HFNC cohort consisted of preterm infants born between 2015-2018 treated with nCPAP, HFNC and LFNC. The primary outcomes were bodyweight and length at six months CA. Multivariate analysis was used after multiple imputation, using a linear or logistic regression depending on the outcome. Results: Of the 598 eligible infants, 271 infants (86.6%) in the nCPAP cohort and 239 infants (83.5%) in the HFNC cohort were included at six months CA with a median GA of 28.1 and 27.6 weeks, respectively. Perinatal characteristics and morbidities were comparable between the epochs (data not shown). No differences in body weight and length at six months CA were reported between the cohorts (Table 1). Infants in HFNC epoch had a prolonged cumulative duration of noninvasive continuous distending pressure (CDP) compared with the nCPAP epoch (31.1 days versus 19.8 days, p< 0.01). Furthermore, in HFNC epoch there was a shift from moderate BPD (odds ratio 0.32, p=0.02) to severe BPD (odds ratio 2.07, p=0.01), compared with nCPAP epoch, after adjusting for confounding variables.
Conclusion(s): The introduction of HFNC as an alternative mode of support for nCPAP did not seem to impact estimated lung growth, compared to exclusive nCPAP support, in preterm infants born < 30 weeks at six months CA. However, the implementation of HFNC did result in an increased cumulative duration of noninvasive CDP and shift from moderate to severe BPD. Further studies are needed to investigate the long-term effect of HFNC on lung development in childhood.
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