A Comparative Study between Postextubation of Preterm Neonates into High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure

Background: For respiratory support in premature newborns, there has been a trend toward less tracheal intubation, less mechanical ventilation, and more nasal respiratory support which can result in the improvement of successful extubation rate. The two commonly known types of nasal respiratory support after extubation are the nasal continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC). The current study aimed to investigate and compare successful extubation using HFNC and conventional nasal CPAP after a period of endotracheal positive pressure ventilation and detect which of these two methods is better for successful extubation with fewer side effects. Methods: This randomized controlled study was conducted on 210 preterm newborns in the neonatal intensive care unit (NICU) of Gynecology and Obstetrics Department of Qasr El Eyni Hospital. Post extubation failure rates were compared between the two groups, namely (HFNC) and (nasal CPAP). The collected data were analyzed in SPSS software (version 20). Results: Neonates who needed re-intubation within 72 h after initial extubation were higher in the HFNC group (72.7%) versus (27.3%) in the CPAP group (P-value=0.063). Moreover, 45.8% of neonates in the HFNC group needed re-intubation within 1 week of initial extubation versus 54.2% in CPAP (P-value=0.970). The mean duration of respiratory support using HFNC was 3.7 days, compared to 6.5 days using CPAP (P-value= 0.001). Among neonates who suffered from nasal trauma, 90.6% of neonates belonged to the CPAP group, while 9.4% of cases belonged to the HFNC group (P-value= 0.001). Conclusion: The use of CPAP and HFNC after the extubation of preterm mechanically ventilated neonates was statistically equal regarding extubation failure.