335 - Predictors of Heated Humidified High Flow Nasal Cannula failure for respiratory support in preterm neonates: A Prospective Observational Study

Publication Number: 335.6465

Rishabh Shukla, Sir Ganga Ram Hospital New Delhi, India, Jhansi, Uttar Pradesh, India; Manoj Modi, Sir Ganga Ram Hospital, New Delhi, Delhi, India; Satish Saluja, Sir Ganga Ram Hospital, NEW DELHI, Delhi, India; Arun Soni, Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, Delhi, Delhi, India; Neelam Kler, Sir GangaRam Hospital India, NEW DELHI, Delhi, India; Pankaj Garg, Sir Ganga Ram Hospital, Delhi, Delhi, India; Anup Thakur, Sir Ganga Ram Hospital, New Delhi, New Delhi, Delhi, India

Background: Heated humidified high flow nasal cannula (HHHFNC) is an alternative modality of non-invasive respiratory support, which has more comfortable interface and hence is better tolerated by neonates and causes less nasal trauma. A proportion of neonates, however, may fail on HHHFNC, requiring upgradation to higher modes of respiratory support. Few studies have evaluated predictors of failure of HHHFNC in preterm neonates. We planned this study to identify predictors for failure of HHHFNC as respiratory support in preterm neonates with RDS.

Objective: To evaluate the predictors for failure of HHHFNC as respiratory support for preterm neonates with respiratory distress as primary mode and as weaning mode, post extubation.

Design/Methods: In this prospective observational study, preterm neonates with respiratory distress receiving HHHFNC, either as primary or post-extubation support were enrolled. Relevant perinatal characteristics were noted prospectively. Failure of HHHFNC was defined as per standard guidelines. Univariate analysis was done to identify factors significantly associated with failure of HHHFNC. Factors with p value < 0.2 were added to logistic regression model to identify independent predictors for HHHFNC failure.

Results: Of total 213 neonates enrolled, 112 received HHHFNC as primary-support and 101 received as post-extubation support. Failure of HHHFNC was 39.3% as primary-support and 54.5% as post-extubation. Downes score and FiO2 at initiation of HHHFNC were found to be independent predictors of failure of HHHFNC as primary-support. Area under curve (95% CI) for Downes score and FiO2 was 0.84 (0.75; 0.92) and 0.86 (0.78; 0.93), respectively. Antenatal steroid use, Downes score and FiO2 at initiation of HHHFNC were found to be independent predictors of failure of HHHFNC as post-extubation support. Area under curve (95% CI) for Downes score and FiO2 was 0.731 (0.63; 0.82) and 0.698 (0.59; 0.80), respectively.

Conclusion(s): Downes score and FiO2 at initiation of HHHFNC were independent predictors of failure of HHHFNC as primary-support. Predictors of HHHFNC failure as post-extubation support were lack of antenatal steroid use, and higher Downes score and FiO2 at initiation.

Table 1: Univariate analysis of predictors for failure of HHHFNC as primary support


Table 2: Univariate analysis of predictors for HHHFNC Failure as post extubation support


Table 3: Logistic regression analysis of predictors for failure of HHHFNC as primary support and post-extubation support