Effectiveness of Humidified High Flow Nasal Cannula Versus Continuous Nasal Positive Airway Pressure in Managing Respiratory Failure in Preterm Infants: An Emergency Department Study

BACKGROUND: Pneumonia is a significant cause of morbidity and mortality in neonates, particularly when accompanied by respiratory failure. This study aims to compare the effectiveness and outcomes of HHFNC and CPAP in improving respiratory outcomes and reducing adverse effects. METHODS: The 220 patients were enrolled in the study (110 in each group) from the neonatal unit, after obtaining written informed consent from their parents/guardians. Nasal CPAP was applied to patients in group A through nasal canula with the following settings FiO2: 40-60%, PEEP: 5-8 cm H2O, flow: 4-6L/min. HHFNC was applied to patients in group B through the nasal cannula with the following setting FiO2: 40-60%, flow: 4-6L/min. Study variables were recorded in the proforma and analyzed using SPSS version 23.0. RESULTS: The comparison of CPAP (Group A) and HHFNC (Group B) showed no significant differences in age, gestational age, or clinical parameters, except for a higher respiratory rate in HHFNC. The HHFNC group had significantly shorter durations of non-invasive ventilatory support and hospital stay. Adverse effects were more common in HHFNC, especially nasal mucosal injury, while sepsis was more frequent in CPAP. Treatment failure occurred more often in the HHFNC group. Neonatal outcomes were similar, with no significant differences in discharge rates, mortality, or intubation rates. CONCLUSION: The study found that the duration of non-invasive ventilator support, shown by HHFNC, was significantly less when compared to CPAP. This suggests that HHFNC might be preferred for providing extended respiratory support in this patient population. Nonetheless, both HHFNC and CPAP appear safe and effective in supporting neonates through their respiratory challenges.