Effect of Nasal Continuous Positive Airway Pressure vs Heated Humidified High-Flow Nasal Cannula on Feeding Intolerance in Preterm Infants With Respiratory Distress Syndrome
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Published:2023-07-12
Issue:7
Volume:6
Page:e2323052
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Cresi Francesco1, Maggiora Elena1, Lista Gianluca2, Dani Carlo3, Borgione Silvia M.1, Spada Elena14, Ferroglio Mattia1, Bertino Enrico1, Coscia Alessandra1, Fiora Michela5, Colombo Sara5, Peila Chiara5, Luciano Mattia5, Meneghin Fabio5, Gatto Sara5, Lupo Enrica5, Elia Serena5, Ciarcià Martina5, Mosca Fabio5, Orsi Anna5, Mercadante Domenica5, Amatruda Matilde5, Tomasini Barbara5, Cecchi Sara5, Liuzzo Lasagna Pamela5, Martinelli Stefano5, Ilardi Laura5, Proto Alice5, Vento Giovanni5, Costa Simonetta5, Fusco Francesca P5, Farina Daniele5, Campagnoli Maria F5, Boetti Tatiana5, Boano Elena5, Sannia Andrea5, De Maio Cinzia5, Murizasco Eleonora5, Raimondi Francesco5, Capasso Letizia5, Salomè Serena5, Agosti Massimo5, Morlacchi Laura5, Perniciaro Simona5, Laforgia Nicola5, Baldassarre Mariella5, Capozza Manuela5, Stronati Mauro5, Civardi Elisa5, Garofoli Francesca5, Maggio Luca5, Corvaglia Luigi5,
Affiliation:
1. Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy 2. Neonatal Pathology and Neonatal Intensive Care Unit, Vittore-Buzzi Children’s Hospital, Milan, Italy 3. Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy 4. Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca’ Granda Ospedale Maggiore Policlinico, Neonatology and Neonatal Intensive Care Unit, Milan, Italy 5. for the ENTARES Study Group
Abstract
ImportanceRespiratory distress syndrome and feeding intolerance are common conditions that are often associated with preterm infants. Showing similar efficacy, nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHHFNC) are the most widespread noninvasive respiratory support (NRS) in neonatal intensive care units, but their effect on feeding intolerance is unknown.ObjectiveTo evaluate the effect of NCPAP vs HHHFNC on high-risk preterm infants with respiratory distress syndrome.Design, Setting, and ParticipantsThis multicenter randomized clinical trial involved infants who were born in 1 of 13 neonatal intensive care units in Italy between November 1, 2018, and June 30, 2021. Preterm infants with a gestational age of 25 to 29 weeks, who were suitable for enteral feeding and who proved to be medically stable on NRS for at least 48 hours were enrolled in the study within the first week of life and randomized to receive either NCPAP or HHHFNC. Statistical analysis was performed according to the intention-to-treat approach.InterventionNCPAP or HHHFNC.Main Outcomes and MeasuresThe primary outcome was the time to full enteral feeding (FEF), defined as an enteral intake of 150 mL/kg per day. Secondary outcomes were the median daily increment of enteral feeding, signs of feeding intolerance, effectiveness of the assigned NRS, peripheral oxygen saturation (SpO2)–fraction of inspired oxygen (FIO2) ratio at changes of NRS, and growth.ResultsTwo-hundred forty-seven infants (median [IQR] gestational age, 28 [27-29] weeks; 130 girls [52.6%]) were randomized to the NCPAP group (n = 122) or the HHHFNC group (n = 125). There were no differences in the primary and secondary nutritional outcomes between the 2 groups. The median time to reach FEF was 14 days (95% CI, 11-15 days) in the NCPAP group and 14 days (95% CI, 12-18 days) in the HHHFNC group, and similar results were observed in the subgroup of infants with less than 28 weeks’ gestation. On the first NRS change, higher SpO2–FIO2 ratio (median [IQR], 4.6 [4.1-4.7] vs 3.7 [3.2-4.0]; P < .001) and lower rate of ineffectiveness (1 [4.8%] vs 17 [73.9%]; P < .001) were observed in the NCPAP vs HHHFNC group.Conclusions and relevanceThis randomized clinical trial found that NCPAP and HHHFNC had similar effects on feeding intolerance, despite different working mechanisms. Clinicians may tailor respiratory care by selecting and switching between the 2 NRS techniques on the basis of respiratory effectiveness and patient compliance, without affecting feeding intolerance.Trial RegistrationClinicalTrials.gov Identifier: NCT03548324
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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