282 - High–flow nasal cannula (HFNC) as a primary respiratory support for very premature infants in the delivery room (DR). A pilot study of effectiveness and safety.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 282
Publication Number: 282.428

Klára Dunajová, General University Hospital in Prague, Prague, Hlavni mesto Praha, Czech Republic; Tereza Lamberská, Charles University in Prague, Prague, Hlavni mesto Praha, Czech Republic; Petr Kudrna, General University Hospital in Prague, Prague, Hlavni mesto Praha, Czech Republic; Richard Plavka, General Faculty Hospital in Prague, Prague, Hlavni mesto Praha, Czech Republic

Presenting Author(s)

Klára Dunajová, MUDr. (she/her/hers)

Trainee
General University Hospital in Prague
Prague, Hlavni mesto Praha, Czech Republic

Background: HFNC is effective for the primary treatment of mild/moderate RDS in premature infants, but its utilization during initial stabilization is unclear.

Objective: To evaluate the effectiveness and safety of HFNC use during stabilization in the DR.

Design/Methods: The premature infants born between 28 + 0 - 31 + 6 gestation were put in the prone position after delayed cord clamping and HFNC of 8 litres flow with FiO2 of 0.3 was introduced. Tactile stimulation started if required. FiO2 titration was based on SpO2. The crossover to NCPAP via rPAP system allowing PPV was performed when despite FiO2 of 1.0, bradycardia persisted within 3 minutes, heart rate fluctuated below 120bpm between 3-5 minutes and SpO2 > 80% was not achieved at 5min. The proceeding infants on HFNC into NICU were changed to NCPAP according to levels of FiO2: > 0.35 within 3 hours and > 0.30 after 3 hours. LISA was performed if FiO2 did not decrease on NCPAP. Supposing a 25% reduction of PPV (from 45% to 20%), a sample size of 65 infants was calculated. HFNC success in the DR and within 3 hours after delivery were defined as criteria of effectiveness and safety.

Results: 65 premature infants were initiated on HFNC. Nine infants failed (14%) in the DR, only 7 of them required PPV (11 %), and none were intubated. Further two infants failed within 3 hours (3%) and 21 after the 3rd hour (32%) in the NICU. Surfactant was administered in 25 infants (38%) in total.

Conclusion(s):

HFNC in this design seems to be an effective (86%) and safe method (83%) of respiratory stabilization in the delivery room, which may reduce the need for positive pressure ventilation in very premature infants. These results evoke questions about how to make our practice effective and improved.