Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress
Background: Humidified high-flow nasal cannula (HHFNC) has gained popularity because it is easier to use, more comfortable for babies, and advantageous for mother-infant bonding. HHFNC is not inferior to other non-invasive ventilators for preventing adverse outcomes, but more studies are needed to e...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-04-01
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| Series: | Pediatrics and Neonatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957219305005 |
| _version_ | 1829487167201607680 |
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| author | Won Young Lee Eui Kyung Choi Jeonghee Shin Eun Hee Lee Byung Min Choi Young Sook Hong |
| author_facet | Won Young Lee Eui Kyung Choi Jeonghee Shin Eun Hee Lee Byung Min Choi Young Sook Hong |
| author_sort | Won Young Lee |
| collection | DOAJ |
| description | Background: Humidified high-flow nasal cannula (HHFNC) has gained popularity because it is easier to use, more comfortable for babies, and advantageous for mother-infant bonding. HHFNC is not inferior to other non-invasive ventilators for preventing adverse outcomes, but more studies are needed to ensure the safe use of HHFNC as an initial respiratory support for newborns. The aim of this study was to investigate risk factors for treatment failure of HHFNC as an initial respiratory support in newborns with respiratory distress after birth. Methods: We included 97 newborns who required non-invasive respiratory support within 24 h after birth. The success group included 68 infants who were successfully managed only on HHFNC, and 29 infants were the failure group who required other respiratory support because of respiratory acidosis, hypoxia, or apnea. Results: Compared with the success group, the failure group had lower GA, a higher rate of antenatal steroid use, prolonged rupture of membrane, lower pH, higher pCO2 on blood-gas analysis after HHFNC application and higher incidence of respiratory distress syndrome of newborn (RDS). After adjusting for GA, higher FiO2 settings during acidosis, hypercarbia after the application of HHFNC shown on blood-gas analysis and the presence of RDS remained significant. The rate of treatment failure was 16.2% for ≥36 weeks, 19.3% for ≥34 weeks, and 22.1% for ≥33 weeks. Conclusion: Treatment failure of HHFNC should be considered a risk for newborns of less than 34 weeks and infants with respiratory distress from RDS. Higher FiO2 settings during HHFNC, and acidosis and hypercarbia after the application of HHFNC shown on blood-gas analysis may help identify high-risk newborns for other non-invasive ventilators or intubation. Key Words: high-flow nasal cannula, newborn infant, noninvasive ventilation, respiratory distress |
| first_indexed | 2024-12-14T23:22:14Z |
| format | Article |
| id | doaj.art-6b681612cf514921b23b5cfeb6086bde |
| institution | Directory Open Access Journal |
| issn | 1875-9572 |
| language | English |
| last_indexed | 2024-12-14T23:22:14Z |
| publishDate | 2020-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj.art-6b681612cf514921b23b5cfeb6086bde2022-12-21T22:43:55ZengElsevierPediatrics and Neonatology1875-95722020-04-01612174179Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distressWon Young Lee0Eui Kyung Choi1Jeonghee Shin2Eun Hee Lee3Byung Min Choi4Young Sook Hong5Department of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaDepartment of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaDepartment of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaDepartment of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaCorresponding author. Department of Pediatrics, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, South Korea. Fax: +82 31 405 8591.; Department of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaDepartment of Pediatrics, Korea University, College of Medicine, Seoul, South KoreaBackground: Humidified high-flow nasal cannula (HHFNC) has gained popularity because it is easier to use, more comfortable for babies, and advantageous for mother-infant bonding. HHFNC is not inferior to other non-invasive ventilators for preventing adverse outcomes, but more studies are needed to ensure the safe use of HHFNC as an initial respiratory support for newborns. The aim of this study was to investigate risk factors for treatment failure of HHFNC as an initial respiratory support in newborns with respiratory distress after birth. Methods: We included 97 newborns who required non-invasive respiratory support within 24 h after birth. The success group included 68 infants who were successfully managed only on HHFNC, and 29 infants were the failure group who required other respiratory support because of respiratory acidosis, hypoxia, or apnea. Results: Compared with the success group, the failure group had lower GA, a higher rate of antenatal steroid use, prolonged rupture of membrane, lower pH, higher pCO2 on blood-gas analysis after HHFNC application and higher incidence of respiratory distress syndrome of newborn (RDS). After adjusting for GA, higher FiO2 settings during acidosis, hypercarbia after the application of HHFNC shown on blood-gas analysis and the presence of RDS remained significant. The rate of treatment failure was 16.2% for ≥36 weeks, 19.3% for ≥34 weeks, and 22.1% for ≥33 weeks. Conclusion: Treatment failure of HHFNC should be considered a risk for newborns of less than 34 weeks and infants with respiratory distress from RDS. Higher FiO2 settings during HHFNC, and acidosis and hypercarbia after the application of HHFNC shown on blood-gas analysis may help identify high-risk newborns for other non-invasive ventilators or intubation. Key Words: high-flow nasal cannula, newborn infant, noninvasive ventilation, respiratory distresshttp://www.sciencedirect.com/science/article/pii/S1875957219305005 |
| spellingShingle | Won Young Lee Eui Kyung Choi Jeonghee Shin Eun Hee Lee Byung Min Choi Young Sook Hong Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress Pediatrics and Neonatology |
| title | Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| title_full | Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| title_fullStr | Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| title_full_unstemmed | Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| title_short | Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| title_sort | risk factors for treatment failure of heated humidified high flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress |
| url | http://www.sciencedirect.com/science/article/pii/S1875957219305005 |
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