High Flow Nasal Cannula in the Treatment of Respiratory Distress Syndrome in One Day-old Neonate

Background: This study was carried out to compare high flow nasal cannula (HFNC) and nasal intermittent mandatory ventilation (NIMV) in respiratory support of one day-old neonates with respiratory distress syndrome (RDS).

Methods: This was a clinical trial conducted in neonatology wards of two university affiliated hospitals from Sep 2013 to Dec 2014. Inclusion criteria were gestational age of 30 to 35 weeks, appropriate weight for gestational age, clinical signs and symptoms of RDS, and RDS suggestive chest-X ray. All patients with RDS were treated with NIMV for one day. Those requiring NIMV respiratory support more than one day and showed the signs of respiratory distress were randomized into two groups of NIMV and HFNC. Each group consisted of 30 patients. Outcome measures included chronic lung disease, mechanical ventilation, failure to treatment, the time to establish full enteral feeding and the mortality rate. In addition, all complications were recorded. Characteristics of the two groups were compared at baseline and after the intervention.

Results: Mean gestational age of patients in NIMV and HFNC groups was 31.81 (1.83) and 31.83 (1.39) weeks, respectively. Distributions of sex, gestational age, height, head circumference, and Apgar scores at the first and fifth minute after the birth were not significantly different between the two groups. Mean (SD) duration of respiratory support after the 1st day was 16.48 (7.80) hours in NIMV group and 18.46 (6.95) in HFNC group (P=0.3). Mean (SD) duration of hospitalization in NICU was 3.24 (0.68) days in NIMV group and 3.2 (0.06) in HFNC group (P=0.8). Mean (SD) age when oral feeding was started, was 23.37 (5.78) hours in NIMV group and 20.13 (5.38) hours in HFNC group (P=0.03). Eleven patients (36.7%) in NIMV group vs. 2 patients in HFNC group required free oxygen therapy (P=0.005). No treatment failure, chronic lung disease, mechanical ventilation or endotracheal intubation was observed in any group. 100% vs. 10% in NIMV and HFNC groups, respectively, experienced grade 3 and 4 nasal mucosal damage (P<0.01).

Conclusion: HFNC was more tolerable than NIMV in the treatment of RDS in premature neonates' ≥30 week-old when applied after the first day of life.