A. Dopper1, M. Steele1,2, F. Bogossian3,4,5, J. Hough1,6
1Australian Catholic University, School of Allied Health, Brisbane, Australia, 2The Prince Charles Hospital, Nursing Research and Practice Development Centre, Brisbane, Australia, 3The University of Queensland, School of Nursing, Midwifery and Social Work, Brisbane, Australia, 4University of the Sunshine Coast, School of Health and Behavioural Sciences, Sippy Downs, Australia, 5Sunshine Coast Health Institute, Birtinya, Australia, 6The University of Queensland, and The Physiotherapy Department, Mater Health Services, Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute, South Brisbane, Australia
Background:
Respiratory failure/distress in infants is the most common reason for non-elective admission to hospitals and neonatal intensive care units. Non-invasive methods of respiratory support have become the preferred mode of treating respiratory problems as they avoid some of the complications associated with intubation and mechanical ventilation. High flow nasal cannula (HFNC) therapy is increasingly being used as a method of non-invasive respiratory support. However, the evidence pertaining to its use in term infants is limited and there is no consensus regarding its safety and efficacy in this population.
Purpose: We aimed to assess the safety and efficacy of HFNC when compared with other forms of non-invasive respiratory support.
Methods: A systematic review of RCTs comparing the outcomes of HFNC in term infants (≥ 37 weeks gestational age up to one-month postnatal age (end of the neonatal period)). Databases: CINAHL, Cochrane CENTRAL, Embase, LILACS, PubMed, Scopus, Web of Science. Primary outcomes: death, treatment failure, chronic lung disease (need for supplemental oxygen at 28 days of life). Secondary outcomes: duration of support, length of stay, adverse effects.
Results: We included eight studies (654 participants). Six studies (625 participants) contributed to the primary analysis. In the comparison of HFNC versus standard oxygen therapy, HFNC is associated with decreased incidences of treatment failure (RR 0.44, 95% CI 0.21 to 0.92, P = 0.03, I2= 0%; low certainty evidence). For HFNC versus continuous positive airway pressure (CPAP), results show decreased incidences of nasal trauma (RR 0.16, 95% CI 0.04 to 0.66, P = 0.01) and abdominal overdistension (RR 0.22, 95% CI 0.07 to 0.71, P = 0.01; very low certainty evidence). The risk of bias across outcomes was generally low, although there were some concerns of bias. The certainty of evidence across outcomes ranged from moderate to very low, downgraded due to risk of bias, imprecision, indirectness, and inconsistency.
Conclusions:
When compared with standard oxygen therapy, HFNC may reduce treatment failure slightly. HFNC may have little to no effect on the duration of respiratory support, length of stay at the ICU, or hospital length of stay, but the evidence is very uncertain. When compared with CPAP, HFNC may result in little to no difference in treatment failure. HFNC may have little to no effect on the duration of respiratory support, but the evidence is very uncertain. HFNC likely results in little to no difference in the length of stay at the intensive care unit. HFNC may reduce the incidence of nasal trauma and abdominal overdistension, but the evidence is very uncertain.
Implications: There is insufficient evidence to enable the formulation of evidence-based guidelines on the use of HFNC in term infants. Larger, methodologically robust trials are required to further evaluate the possible health benefits or harms of HFNC in this patient population. No studies were set up to specifically investigate term infants during the neonatal period, suggesting this population could be underrepresented in the literature. We identified a notable gap in the literature regarding the effect of HFNC on chronic lung disease, highlighting an area for future RCTs to explore.
Funding acknowledgements: The work was unfunded.
Keywords:
High flow nasal cannula
Neonate
Cochrane review
High flow nasal cannula
Neonate
Cochrane review
Topics:
Paediatrics
Cardiorespiratory
Primary health care
Paediatrics
Cardiorespiratory
Primary health care
Did this work require ethics approval? No
Reason: This was a Cochrane systematic review.
All authors, affiliations and abstracts have been published as submitted.
