Admission to NICU in air is more likely if nasal high flow is used for stabilisation in preterm babies compared to face mask CPAP

Abstract

Objective. To examine the success of stabilisation and the short term outcomes from the routine use of nasal high flow (nHF) on an unselected cohort of babies in the delivery room (DR). Design. Retrospective single-centre study Setting. Single-centre neonatal intensive care unit (NICU) Patients. Infants born at < 32 weeks gestation Interventions. Stabilisation and transfer to NICU of an unselected cohort of babies using nHF Main outcome measures. Success of stabilisation defined by successful transfer on nHF and clinical measures of stability at admission to NICU, including oxygen requirement, admission temperature, surfactant requirement, short term outcomes and whether infants were sustained on nHF by 72 hours of age. Results. There were 133 eligible babies. 54 were commenced on nHF in the DR (Group A), 47 were stabilised by face mask CPAP (continuous positive airway pressure) (Group B), 26 were intubated (Group C); 6 required only minimal respiratory support (Group D). Median maturity varied between the groups (Group A 27+5 weeks, Group B 30 weeks, Group C 26+2 weeks, Group D 31+5). 72% of Group A and 75% of Group B remained on nHF for 72 hours (P=0.82). Fewer babies received surfactant in Group A versus Group B (29% vs 35%; P=0.67), however groups were not matched for maturity differences and Group A were significantly less mature and of lower birthweight (both P<0.001). Group A were significantly more likely to be in air at admission than Group B (P=0.03). Conclusion. Preterm babies can be successfully stabilised and sustained on nHF. The use of nHF for immediate stabilisation appears to be effective and, in this study, led to significantly more babies being in air on admission to the NICU compared to face mask CPAP stabilisation.