Hamodynamic Changes with Heated, Humidified High Flow Nasal Cannula (HHFNC) Versus Nasal Continuous Positive Airway Pressure (nCPAP) for Respiratory Support in Preterm Neonates

Abstract

In addition, when we compared those who succeeded and those who failed the HHFNC, the mean gestational age in the HHFNC failed group was significantly lower than that in the succeeded group (31.9 vs. 32.7 weeks respectively, P=0.046). Also, the mean birth weight in the HHFNC failed group was significantly lower than that in the succeeded group (1.68 vs. 1.95 Kg respectively, P=0.016). As regard the maximum FiO2 required to maintain saturation between 88–94% during HHFNC treatment, it was found to be significantly lower in the succeeded group when compared to the failed group (27.1 vs. 47.5 % respectively, P=0.000). Also, our trial showed a significantly longer period of duration of hospitalization among the HHFNC failed group when compared to the succeeded group (19.44 ± 7.54 vs. 14.51 ± 5.94 days, P=0.001), and a significantly lower survival rate in the failed group as compared to the succeeded group (P=0.000). We also showed by additional assessment of complications a significantly higher incidence of NEC among the HHFNC and CPAP failed groups when compared to the succeeded groups (P=0.002 and P=0.037 respectively). Furthermore, we found a significantly higher incidence of sepsis in the HHFNC and CPAP failed groups as compared to the succeeded groups (56.2% vs. 27.7%, P=0.038 and 84.6% vs. 31.9%, P=0.001 respectively). Of the 123 preterm infants included, 70 were subjected to pulsed Doppler echocardiography, cerebral Doppler and pre-prandial mesenteric Doppler at the time of weaning. This was done while on and 1 hour after being off either HHFNC or nCPAP according to the allocated group. Both groups showed significantly decreased SMA flow (ml/sec) (32 vs. 41.8) and (31.6 vs. 40.7) respectively with no significant mean difference between the 2 groups. Both groups didn’t show significant influence on ACA RI, SVC flow, RVO and LVO. With significant mean difference between HHFNC and nCPAP groups in LVO (ml/kg/min) (9.9 ± 47 vs. -12.04 ± 37.04) (P =.005).