High-flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in preterm infants: a meta-analysis of randomized controlled trials

Background: As a noninvasive respiratory support mode, high-flow nasal cannula (HFNC) is widely used in preterm infants at neonatal care units. HFNC is often used as an alternative to nasal continuous positive airway pressure (NCPAP) for initial or post-extubation respiratory support. The purpose of this meta-analysis is to evaluate and compare the efficacy and safety of HFNC and NCPAP for respiratory support in preterm infants. Methods: We searched PubMed, Web of Science, Embase, Cochrane Library, Clinicaltrials.gov, Controlled-trials.com, Google Scholar, VIP, and Wang Fang for articles from their inception to December 2018. All published randomized controlled trials (RCTs) evaluating and comparing the effects of HFNC and NCPAP therapy for primary respiratory support in newborns were included. All meta-analyses were performed using Review Manager 5.3. Results: In total, 21 RCTs involving 2886 preterm infants were included. The results of the meta-analysis revealed the following: (1) for primary respiratory support, the rates of treatment failure at trial entry were similar between HFNC and CPAP (relative risk 1.03, 95% confidence interval 0.79–1.33), and HFNC had reduced nasal trauma (p < .00001); and (2) for respiratory support after extubation, CPAP was associated with a lower likelihood of treatment failure than HFNC (relative risk 1.23, 95% confidence interval 1.01–1.50). The incidences of nasal trauma and pneumothorax in the HFNC group were significantly lower than that in the CPAP group (p < .0001 and p = .03). Serious adverse events did not significantly differ. Conclusions: HFNC had effects similar to those of CPAP regarding the failure of initial respiratory support in premature infants and was associated with reduced nasal trauma compared to CPAP. Following extubation, CPAP had fewer treatment failures than HFNC, but CPAP had a significantly increased rate of nasal trauma and pneumothorax. Further studies are needed to clarify the potential benefits of HFNC as primary respiratory support in extremely low birth weight or extremely preterm infants.