666 - Continuous Positive Airway Pressure versus High-Velocity Nasal Cannula for Weaning Respiratory Support of Preterm Infants

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 666
Publication Number: 666.442

Tatiana A. Nuzum, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Gurpreet Kaur, New York University Grossman School of Medicine, new york, NY, United States; Natalia Mavrogiannis, NYU Langone, New York, NY, United States; Kristyn A.. Pierce, New York University Grossman School of Medicine, New York, NY, United States; Maya G. Hatley, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States; Isabelle A. Bautista, Saint Peter’s University, Jersey City, NJ, United States; Jasmine E. Forbes, Spelman College, Cibolo, TX, United States; Heather Howell, NYU Grossman School of Medicine, NY, NY, United States; Purnahamsi Desai, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Erin Cicalese, New York University Grossman School of Medicine, New York, NY, United States

Presenting Author(s)

Tatiana A. Nuzum, MB BCh BAO (she/her/hers)

Neonatal-Perinatal Medicine Fellow
Hassenfeld Children's Hospital at NYU Langone
New York, New York, United States

Background: Chronic Lung Disease (CLD) of Prematurity is one of the most clinically significant co-morbidities that the vulnerable preterm population faces, as it directly correlates with mortality and neuro-developmental outcomes. The use of various non-invasive respiratory support devices has been shown to decrease the duration of intubation and as a result, the incidence of CLD. However, there is limited information available regarding the optimal mode of non-invasive respiratory support. Two commonly used modalities include Continuous Positive Airway Pressure (CPAP) and High Velocity Nasal Cannula (HVNC). HVNC was introduced in our institution in 2018 and quickly became the more frequently used modality due to a variety of factors including ease of use and patient tolerance.

Objective: The primary objective of this study was to compare the rates of CLD in infants < 34 weeks gestational age (GA), between those weaned primarily with CPAP and those weaned primarily with HVNC. The secondary objectives were to compare respiratory complications, skin complications, time to wean to room air, and length of stay between the 2 groups.

Design/Methods: This study was a retrospective, observational cohort study at a level IV Neonatal Intensive Care Unit including all preterm infants born less than 34 weeks GA on non-invasive respiratory support above 2 liters per minute for longer than 5 days, over a 3-year period. Maternal and infant demographics, and clinical data from the infant’s hospital course were collected. The CPAP cohort was defined as patients who were treated with CPAP more than 50% of the days they were on non-invasive support while the HVNC group was defined as patients treated with HVNC more than 50% of the days they were on non-invasive support.

Results: Demographics and clinical characteristics were similar between the CPAP group (n=175) and the HVNC group (n=48) (Table 1). The rates of CLD were significantly higher in the HVNC group as compared to the CPAP group (58.3% vs 24.6%, p< 0.001) (Table 2). This difference persisted after logistic regression was performed accounting for variables including GA, invasive respiratory support requirement and administration of antenatal corticosteroids. Additionally, the HVNC group remained on respiratory support for a longer duration (55 days vs 27 days, p < 0.001), and had longer hospital stays (82.5 days vs 54 days, p< 0.001) (Table 3).

Conclusion(s): When used as the primary modality of non-invasive respiratory support, HVNC resulted in significantly higher rates of CLD and an increased length of stay.