Admission to NICU in air is more likely if nasal High Flow is used for stabilisation in preterm babies compared to face mask CPAP

Objective. To examine the success of stabi-lisation and the short term outcomes from the routine use of nasal high flow (nHF) on an unselected cohort of babies in the deliv-ery room (DR).

Design. Retrospective single-centre study Setting. Single-centre neonatal intensive care unit (NICU)

Patients. Infants born at < 32 weeks gesta-tion

Interventions. Stabilisation and transfer to NICU of an unselected cohort of babies us-ing nHF

Main outcome measures. Success of sta-bilisation defined by successful transfer on nHF and clinical measures of stability at admission to NICU, including oxygen requirement, admission temperature, sur-factant requirement, short term outcomes and whether infants were sustained on nHF by 72 hours of age. 

Results. There were 133 eligible babies. 54 were commenced on nHF in the DR (Group A), 47 were stabilised by face mask CPAP (continuous positive airway pressure) (Group B), 26 were intubated (Group C); 6 required only minimal res-piratory support (Group D). Median ma-turity varied between the groups (Group A 27+5 weeks, Group B 30 weeks, Group C 26+2 weeks, Group D 31+5). 72% of Group A and 75% of Group B remained on nHF for 72 hours (P=0.82). Fewer ba-bies received surfactant in Group A versus Group B (29% vs 35%; P=0.67), however groups were not matched for maturity dif-ferences and Group A were significantly less mature and of lower birthweight (both P<0.001). Group A were significantly more likely to be in air at admission than Group B (P=0.03).

Conclusion. Preterm babies can be suc-cessfully stabilised and sustained on nHF. The use of nHF for immediate stabilisation appears to be effective and, in this study, led to significantly more babies being in air on admission to the NICU compared to face mask CPAP stabilisation.  

nasal High Flow cannula, deliv-ery room, stabilisation, premature

1. Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European resuscitation council guidelines for resuscita-tion 2015: section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015;95:249-63.

2. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update. Neonatology 2017;111(2):107-25.

3. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362:1970-9.

4. Schmölzer GM, Kumar M, Pichler G, Aziz K, O’Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 2013;347:f5980.

5. Reynolds P, Leontiadi S, Lawson T, Otunla T, Ejiwumi O, Holland N. Stabilisation of premature infants in the DR with nasal high flow. Arch Dis Child Fetal Neonatal Ed 2016;101:F284-7.

6. Yoder BA, Stoddard RA, Li M, King J, Dirnberger DR, Abbasi S. Heated humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates. Pediatrics 2013;131:e1482-90.

7. Collins CL, Holberton JR, Barfield C, Davis PG. A randomised controlled trial to compare heated humidified high-flow nasal can-nulae with nasal continuous positive airway pressure postextubation in premature infants. J Pediatr 2013;162:949-54.e1.

8. Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, et al. High-flow nasal cannulae in very preterm in-fants after extubation. N Engl J Med 2013;369:1425-33.