Is High-Flow Nasal Cannula Noninferior to Nasal CPAP for the Initial Management of Preterm Infants?

Effective ventilatory support is essential to the survival of extremely preterm infants in the NICU; however, much is still unknown regarding avoidance of treatment failure and progression to invasive mechanical ventilation. This randomized trial assessed the effectiveness of high flow nasal cannula versus nasal CPAP among infants >28 weeks’ gestational age with early RDS, and found an increase in treatment failure among infants receiving high flow nasal cannula.

Delivering non-invasive positive pressure to prevent extubation failure in preterm infants: nasal CPAP remains the standard of care

CPAP Lowering extubation failures in very preterm infants remains an important goal. For this purpose and upon extubation, high-flow nasal cannulae (HFNC) and nasal CPAP were compared. Extubation failure occurred in 34% randomized to HFNC, and in 26% randomized to CPAP. Apnea was the most common cause of extubation failure in both groups. These data provide no compelling argument that HFNC should be considered as equivalent to nasal CPAP as the current standard of care to prevent extubation failure.