Nasal Continuous Positive Airway Pressure Versus Heated Humidified High-Flow Nasal Cannula for Post-Extubation Management in Preterm Neonates with Respiratory Distress Syndrome: A Pilot Randomized Controlled Trial

Abstract

Background: Respiratory distress syndrome (RDS) remains a major challenge in neonatal intensive care. Although nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHFNC) are widely used noninvasive ventilatory modalities, comparative data on their postextubation efficacy in preterm neonates with RDS remain limited. Objectives: To compare the clinical efficacy and safety of NCPAP and HHFNC as post-extubation respiratory support in preterm infants with RDS, focusing on the duration of oxygen therapy, length of hospital stay, treatment failure, and major neonatal complications. Methods: In this parallel-group, open-label pilot randomized trial, 54 preterm infants with RDS who were extubated after surfactant therapy were assigned in a 1:1 ratio to NCPAP (n = 27) or HHFNC (n = 27). The primary outcome was the duration of supplemental oxygen therapy. Analyses followed the intention-to-treat principle. Generalized linear models were adjusted for baseline covariates. Results: All 54 infants were included in the analysis. In adjusted models, the HHFNC group had a significantly longer duration of oxygen therapy (adjusted mean difference, 18.32 hours; 95% CI, 1.21 - 35.44; P = 0.036) and a longer hospital stay (adjusted mean difference, 125.38 hours; 95% CI, 29.66 - 221.10; P = 0.010) than the NCPAP group. No treatment failures (reintubations) occurred in either group. No significant differences were observed in nasal trauma (adjusted OR, 2.78; 95% CI, 0.43 - 17.79; P = 0.281), pneumothorax, intraventricular hemorrhage, or FiO2 requirements at 24 hours. Conclusions: Post-extubation HHFNC was associated with longer durations of oxygen dependence and hospitalization than NCPAP in preterm infants with RDS. Although rates of major complications were comparable, the pilot nature of the study limited the precision of the estimates, and larger trials are needed to confirm these findings.