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Systematic review of high-flow nasal cannula versus continuous positive airway pressure for primary support in preterm infants
  1. Shaam Bruet1,
  2. Marine Butin2,3,
  3. Frederic Dutheil4,5
  1. 1 Neonatology and NICU, CHU Clermont-Ferrand, Clermont-Ferrand, France
  2. 2 Neonatology and NICU, Hospices Civils de Lyon, Lyon, France
  3. 3 Staphylococcal pathogenesis research group, International Center for Infectiology Research, INSERM U1111, Lyon, France
  4. 4 Physiological and Psychosocial Stress, LaPSCo, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
  5. 5 Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand, Witty Fit, F-63000, CHU Clermont-Ferrand, Clermont-Ferrand, France
  1. Correspondence to Dr Shaam Bruet, Neonatology and NICU, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; shaam1991{at}hotmail.com

Abstract

Introduction We conducted a meta-analysis of trials that compared efficacy and safety of high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants and a study of the impact of clinical relevant parameters.

Methods Databases were searched for randomised controlled trials comparing HFNC with CPAP as primary respiratory support in preterm infants. Treatment failure was considered as primary outcome and adverse events as secondary outcomes. We calculated risk ratios (RRs) in intention-to-treat analysis and random-effects meta-analyses of risks were conducted.

Results We included 10 studies for a total of 1830 patients. Meta-analysis demonstrated an RR of treatment failure multiplied by 1.34 using HFNC compared with CPAP (RR=1.34, 95% CI 1.01 to 1.68, I2=16.2%). Secondary outcome meta-analysis showed no difference in intubation rates (RR=0.90, 95% CI 0.66 to 1.15) and a lower rate of nasal trauma using HFNC compared with CPAP (RR=0.48, 95% CI 0.31 to 0.65, I²=0.0%). Meta-regressions did not show any influence of gestational age and weight at birth, HFNC flow rate, type of CPAP generator or use of surfactant.

Conclusions Despite a higher risk of treatment failure, considering no difference in intubation rates and a lower rate of nasal trauma using HFNC compared with CPAP, we suggest that HFNC should be used as primary respiratory support in preterm infants.

  • neonatology
  • therapeutics

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, SB, upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, SB, upon reasonable request.

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Footnotes

  • Contributors SB and FD conceived of the presented idea. SB and FD did the literature research. FD supervised this work. MB checked the findings of this work. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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