Clinical Outcomes of High-Flow Nasal Cannula vs Bubble CPAP in Neonatal Intensive Care Unit

Abstract

Background: Respiratory distress (RD) is the leading cause for admission to the NICU within the first 48-72 h of life, affecting both term and preterm infants. Restoring functional residual capacity (FRC) is crucial in RD treatment. Noninvasive techniques like CPAP and high-flow nasal cannula (HFNC) have gained favor due to their ability to improve outcomes and reduce lung injury compared to intubation. Recent studies support the effectiveness of HFNC and other noninvasive modalities, but a gap exists in directly comparing HFNC and bubble CPAP regarding their impact on reducing intubation rates in the NICU. This study aims to assess the efficacy of HFNC compared to bubble CPAP in delaying the need for intubation among neonates with RD admitted to the NICU.

Methods: We conducted a retrospective single-center study to assess the effectiveness of HFNC compared to CPAP in 69 neonates with RD admitted to the NICU between 2016 and 2023. Data analysis using SPSS software compared intubation rates, device tolerance, and physiologic parameters (frequency, heart rate, and SpO₂) between groups using statistical tests.

Results: The HFNC group had a higher tolerance rate compared to bubble CPAP (95.8% vs 66.7%; P = .006). However, there was no significant difference between the two groups in terms of intubation(P-value = .59). Moreover, no differences were observed between the two groups in baseline demographic or physiological characteristics

Conclusions: The study demonstrates the effectiveness of both HFNC and bubble CPAP in managing respiratory distress. However, due to more tolerance among term and preterm infants with HFNC, the study suggests the use of HFNC as a potential preferred noninvasive primary respiratory support strategy. Further confirmation is needed through larger, prospective, and multicenter studies to solidify these findings.