For newborns needing oxygen support, high-flow nasal cannula disappoints

  • Manley BJ & al.
  • N Engl J Med
  • 23 May 2019

  • International Clinical Digest
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Takeaway

  • For newborn infants aged ≥31 weeks of gestation, high-flow oxygen therapy via nasal cannula is not noninferior to nasal continuous positive airway pressure (CPAP).
  • CPAP is likely superior.

Why this matters

  • Although associated with lower rate of treatment failure and transfer to a tertiary neonatal ICU (NICU), nasal CPAP has been linked to pneumothorax and requires special expertise.
  • High-flow therapy is a popular alternative.
    • It has been linked to higher treatment-failure rates in NICUs.
    • Special-care nursery populations comprise older infants with fewer comorbidities who might be expected to respond more favorably.

Key results

  • Mean gestational age, 36.9 weeks; mean birth weight, 2909 g.
  • High-flow vs CPAP:
    • Treatment failure: 20.5% (78/381) vs 10.2% (38/373);
      • Risk difference, 10.3 percentage points (95% CI, 5.2-15.4).
    • Per-protocol (n=677): 14.5% (49/339) vs 8.0% (27/338);
      • Risk difference, 6.5 percentage points (95% CI, 1.7-11.2).
    • Similar between-group rates of mechanical ventilation, transfer to tertiary NICU, adverse events.

Study design

  • Randomized noninferiority HUNTER trial in 9 nontertiary special-care nurseries (n=754). 
  • Neonates aged ≥31 weeks of gestation with respiratory distress, birth weight ≥1200 g were randomly assigned to high-flow therapy vs CPAP.
  • Outcome: treatment failure within 72 hours.
  • Funding: Australian National Health and Medical Research Council; Monash University.

Limitations

  • Nonblinded.

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