High-Flow Nasal Cannula Versus Nasal CPAP as Primary Support in Preterm Respiratory Distress Syndrome

Heated Humidified High-Flow Nasal Cannula Versus Nasal Continuous Positive Airway Pressure as Primary Respiratory Support in Preterm Infants With Respiratory Distress Syndrome: A Randomized Controlled Trial

This single-center randomized controlled trial compared heated humidified high-flow nasal cannula (HHHFNC) with nasal continuous positive airway pressure (nCPAP) as primary noninvasive respiratory support in preterm infants (gestational age 28-34 weeks; birth weight 1000-2000 g) with moderate respiratory distress syndrome. The primary outcome was treatment failure requiring invasive mechanical ventilation within the first 7 days.

Eighty-six infants were randomized 1:1 to HHHFNC (n=43) or nCPAP (n=43). Both arms followed identical surfactant, escalation, and weaning protocols. Outcomes included treatment failure, nasal trauma, sepsis, feeding intolerance, and time to full enteral feeding.

Inclusion Criteria:

Preterm infants admitted to the NICU who fulfilled all of the following were eligible:

1. Gestational age (GA) 28+0 to 34+6 weeks and/or birth weight 1,000-2,000 g
2. Clinical and radiological diagnosis of moderate respiratory distress syndrome (RDS)
3. Silverman-Anderson score (SAS) 4 < SAS < 7
4. Eligibility for noninvasive ventilatory support

Exclusion Criteria:

1. Parental refusal of consent
2. Outborn infants transferred from other centers
3. Infants who required immediate intubation in the delivery room
4. Major congenital anomalies, chromosomal disorders, gastrointestinal malformations, or life-threatening congenital cardiac defects
5. Nasal/pharyngeal anatomical anomalies (choanal atresia, cleft palate/lip)
6. Moderate-to-severe hypoxic-ischemic encephalopathy (Grade 2-3)
7. Infants who died unexpectedly shortly after admission without respiratory evaluation