Comparing the Effectiveness of Nasal Continuous Positive Airway Pressure (NCPAP) and High Flow Nasal Cannula (HFNC) in Prevention of Post Extubation Assisted Ventilation

There is a growing trend toward avoidance of intubation and mechanical ventilation for preterm neonates. Noninvasive ventilation can be provided by a variety of ways including nasal cannula. This study was conducted to compare the efficacy and safety of Humidified high Flow Nasal Cannula (HFNC) and nasal CPAP for respiratory support after surfactant administration in preterm newborn infants with respiratory distress syndrome. Patients and In this randomized controlled clinical trial, 85 preterm newborn infants with birth weight of 1250 - 2000 grams and gestational age of 30 - 34 weeks who received surfactant replacement therapy were enrolled. Patients were randomly allocated in two groups; NCPAP group (43 neonates) and HFNC group (42 neonates). The mean gestational age of patients was 32.07 ± 1.48 weeks in NCPAP and 32.24 ± 1.7 weeks in HFNC group and their birth weight was 1885 ± 417 and 1905 ± 464 grams in NCPAP and HFNC groups, respectively. Demographic characteristics of patients were similar in the both groups. Although the rate of re-intubation, pneumothorax, intra-ventricular hemorrhage and bronchopulmonary dysplasia were higher in NCPAP group, the differences were not statistically significant. Nasal mucosa injury was determined in 27 (62.8%) neonates in NCPAP group and 14 (33.3%) infants in HFNC group (P = 0.007). In our study, HFNC was as effective as NCPAP for respiratory support in preterm infants after surfactant administration and extubation. Nasal mucosal injury rate was lower in HFNC group. It is recommended to perform future studies with larger number of patients before routine use of HFNC in post extubated preterm infants.