663 - High-flow nasal cannula versus nasal continuous positive airway pressure in the feeding tolerance of preterm infants: a secondary analysis of the NIPPN study

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 663
Publication Number: 663.442

Yohei Minamitani, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Shuntaro Oka, Saitama Medical Center, Kawagoe, Saitama, Japan; Atsushi Uchiyama, Department of Pediatrics, Tokai University School of Medicine, Isehara city, Kanagawa, Japan; Kaoru Okazaki, Tokyo Metropolitan Children's Medical Center, Fuchu-si, Tokyo, Japan; Masatoshi Kondo, Children's Hospital, Fucyu, Tokyo, Japan; Nobuhiko Nagano, Nihon University, Itabashi-ku, Tokyo, Japan; Akira Kobayashi, Niigata University, Niigata, Niigata, Japan; Yoshiki Soeno, Nagaoka Redcross Hospital, Nagaoka, Niigata, Japan; Hidehiko Maruyama, National Center for Child Health and Development, Setagaya, Tokyo, Japan; Yushi Ito, National Center for Child Health and Development, Tokyo, Tokyo, Japan; Fumihiko Namba, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

Presenting Author(s)

Yohei Minamitani, MD (he/him/his)

Assistant Professor of Pediatrics
Saitama Medical Center, Saitama Medical University
Kawagoe, Saitama, Japan

Background: High-flow nasal cannula (HFNC) and nasal continuous positive airway pressure (NCPAP) or noninvasive positive-pressure ventilation (NIPPV) are frequently selected as post-extubation respiratory therapy in preterm infants. In the previous randomized controlled trial (NIPPN study), we reported that HFNC showed a significantly higher rate of treatment failure than NCPAP/NIPPV following extubation. However, HFNC is generally considered to have fewer enteral feeding problems than NCPAP/NIPPV; however, there are few reports about the superiority of HFNC in feeding tolerance.

Objective:

This study aimed to assess the relationship between HFNC use and feeding tolerance as a secondary analysis of the NIPPN study.

Design/Methods:

This retrospective study included preterm infants born at < 34 weeks of gestational age (GA) who needed noninvasive ventilation after extubation and were randomly assigned to the HFNC or NCPAP/NIPPV group from April 2015 to September 2018. Postmenstrual age (PMA) at the first oral feeding, full oral feeding (160 mL/kg/day), and last tube feeding; body weight at 36 weeks of PMA and discharge; and daily weight gain from extubation to 36 weeks of PMA and discharge were compared between the two groups. Clinical data were collected from medical records. Outcome data were analyzed using Fisher’s exact test or the Mann–Whitney U test as appropriate. Multivariate regression models were applied with adjustment for birth weight, male sex, Apgar score at 1 min, bronchopulmonary dysplasia, intraventricular hemorrhage, treated patent ductus arteriosus, and necrotizing enterocolitis. Intention-to-treat and per-protocol analyses were performed.

Results:

Of the 338 infants, 157 and 181 were allocated to the HFNC and NCPAP/NIPPV groups, respectively. In the intention-to-treat analysis, no statistically significant differences in predefined outcomes between the two groups were observed. In the per-protocol analysis, the HFNC group showed greater daily weight gain from extubation to discharge among all patient groups (24.2 vs. 22.4 g/day, P = 0.04) and higher weight at 36 weeks of PMA in a subgroup of GA < 28 weeks (1,809 vs. 1,730 g, P = 0.046) after adjusting for confounding factors.

Conclusion(s): HFNC was associated with greater daily weight gain in all infants and higher weight at 36 weeks of PMA in infants born < 28 weeks of GA. In preterm infants, particularly those born < 28 weeks of GA, HFNC use may improve weight gain compared with NCPAP/NIPPV.