Shin Jeonghee, Park Kyuhee, Lee Eun Hee, Choi Byung Min
Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
So Pediatric Clinic, Seoul, Korea.
J Korean Med Sci. 2017 Apr;32(4):650-655. doi: 10.3346/jkms.2017.32.4.650.
Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [-1.90-36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress.
加热湿化高流量鼻导管（HHFNC）常用于对患有呼吸窘迫的早产儿进行无创呼吸支持。但仅有有限的研究将HHFNC与鼻持续气道正压通气（nCPAP）作为早产儿出生后立即出现呼吸窘迫的初始治疗方法进行比较。本研究的目的是评估HHFNC与nCPAP相比，作为患有呼吸窘迫的早产儿初始治疗方法的有效性和安全性。胎龄在30至35周之间的早产儿在出生后24小时内出现呼吸窘迫时，被随机分为HHFNC组或nCPAP组。需要有创呼吸支持的早产儿被排除。主要结局是治疗失败的发生率（定义为需要插管或机械通气）。对85名婴儿进行了分析。随机分配至HHFNC组的42名婴儿中有16名出现治疗失败，而使用nCPAP的43名婴儿中有9名出现治疗失败（风险差异17.17[-1.90 - 36.23]；P = 0.099）。就治疗失败的原因而言，HHFNC组的低氧频率显著高于nCPAP组（P = 0.020）。两组在呼吸和临床结局及并发症方面无差异。尽管与nCPAP相比HHFNC是安全的，但尚不确定HHFNC作为患有呼吸窘迫的早产儿的初始呼吸支持与nCPAP相比是否具有非劣效性疗效。
