Shimizu Daisuke, Araki Shunsuke, Kawamura Masaru, Kuwamura Mami, Suga Shutaro, Miyake Fuyu, Ichikawa Shun, Kinjo Tadamune, Kusuhara Koichi
Center of Maternal, Fetal and Neonatal Medicine, Hospital of the University of Occupational and Environmental Health, Japan.
Department of Neonatology, Fukuoka Children's Hospital.
J UOEH. 2019;41(2):131-138. doi: 10.7888/juoeh.41.131.
Previous studies on high-flow nasal cannula (HFNC) in very-low-birth-weight infants (VLBWIs) focused on comparing HFNC with nasal continuous positive airway pressure (nCPAP) to determine the usefulness of HFNC as a backup in the case of extubation failure and nasal trauma; however, the studies did not consider oral feeding. This retrospective case-control study aimed at elucidating whether HFNC could prevent the delay in feeding and achievement of full oral feeding in VLBWIs with chronic lung disease (CLD). Forty five VLBWIs were enrolled in this study: an HFNC group (n = 11) that was supported by HFNC at oral feeding initiation, and a non-HFNC group (n = 34) that could start oral feeding without HFNC. The gestational age and birth weight of the HFNC group were lower than those in the non-HFNC group. The median duration of exposure to oxygen and neonatal intensive care unit stay were comparable in both groups. The timings of oral feeding initiation and full oral feeding achievement in both groups were not significantly different: 35.3 (33.0 - 38.1) vs. 35.5 (33.7 - 42.4) weeks (P = 0.91) for the HFNC and 38.6 (34.4 - 42.3) vs. 36.7 (34.6 - 44.4) weeks postmenstrual age (P = 0.29) for the non-HFNC. Clinically significant aspiration pneumonia during the period of oral feeding was not observed in the HFNC group. Respiratory support by HFNC in VLBWIs with CLD might prevent oral feeding delay. Initiation of oral feeding of VLBWIs on HFNC might be safe and might accelerate the achievement of oral feeding milestones.
以往针对极低出生体重儿（VLBWIs）使用高流量鼻导管（HFNC）的研究主要集中在比较HFNC与经鼻持续气道正压通气（nCPAP），以确定HFNC在拔管失败和鼻外伤情况下作为备用方法的有效性；然而，这些研究未考虑经口喂养。这项回顾性病例对照研究旨在阐明HFNC是否能预防慢性肺病（CLD）的VLBWIs出现喂养延迟及实现完全经口喂养。本研究纳入了45例VLBWIs：一个HFNC组（n = 11），在开始经口喂养时接受HFNC支持；以及一个非HFNC组（n = 34），无需HFNC即可开始经口喂养。HFNC组的胎龄和出生体重低于非HFNC组。两组的吸氧中位时长和新生儿重症监护病房住院时间相当。两组开始经口喂养和实现完全经口喂养的时间无显著差异：HFNC组为35.3（33.0 - 38.1）周 vs. 35.5（33.7 - 42.4）周（P = 0.91），非HFNC组为月经龄38.6（34.4 - 42.3）周 vs. 36.7（34.6 - 44.4）周（P = 0.29）。HFNC组在经口喂养期间未观察到具有临床意义的吸入性肺炎。在患有CLD的VLBWIs中，HFNC进行呼吸支持可能会预防经口喂养延迟。在HFNC上对VLBWIs开始经口喂养可能是安全的，并且可能会加速实现经口喂养里程碑。
