Comparing Heated Humidified High Flow Nasal Cannula to Nasal Continuous Positive Airway Pressure as post-extubation respiratory support in preterm infants: A comprehensive systematic review and meta-analysis

Abstract

Background This study aims to compare the efficacy and complications of CPAP with HHHFNC, as post-extubation modalities for respiratory support in neonates.Methods A comprehensive search was conducted in five electronic databases: MEDLINE (via PUBMED), Scopus, Web of Science, Google Scholar, and Embase in September 2022; screening observational and clinical trial studies for eligibility. Primary outcomes of the study included extubation failure at 72 hours and at 7 days.Results Nine clinical trials were included, encompassing 1471 infants. Extubation failure at 72 days was more common with HHHFNC although insignificantly (OR = 3.40, 95 CI: 0.87, 13.23), but it was found to be significantly higher at 7 days when opting for HHHFNC (OR = 1.65, 95 CI: 1.02, 2.67). In an overall analysis, extubation failure was significantly higher in infants treated with HHHFNC (OR = 1.61, 95 CI: 1.14, 2.26). Among secondary outcomes, nasal trauma was significantly higher when CPAP was utilized (OR = 0.20 95 CI: 0.10, 0.42). Meta-analysis suggests that there are no differences in the risks for BPD (OR = 1.27, 95 CI: 0.79, 2.06), ROP (OR = 0.88, 95 CI: 0.51, 1.52), NEC (OR = 0.63, 95 CI: 0.41, 0.97), PVL (OR = 0.71, 95 CI: 0.29, 2.96), IVH (OR = 1.04, 95 CI: 0.53, 2.04), and mortality (OR = 0.96, 95 CI: 0.56, 1.66).Conclusion According to our review, CPAP remains the choice of non-invasive respiratory support modality regarding its lower risk for extubation failure. Although nasal trauma continues to be a challenging side effect for neonates treated with CPAP, other neonatal complications are equally prevalent when comparing CPAP and HHHFCN.