Background and aims: Heated humidified high flow nasal cannula (HFNC) is beneficial post-extubation respiratory support in very low birth weight infants (VLBWIs). Given that oral feeding and spontaneous movement are minimally restricted, HFNC might be associated with earlier establishment of oral feeding, shorter hospital stay, and better developmental outcomes.
We aim to examine whether HFNC is associated with shorter hospital stay in VLBWIs compared with NCPAP.

Methods: The protocol was approved by the local institutional review board. Clinical data from 281 VLBWIs were retrospectively reviewed. HFNC (8 L/min) is used for weaning from NCPAP according to its availability and the decision of consultant neonatologists. Dependence of primary (postnatal age at hospital discharge) and secondary (commencement and establishment of oral feeding, and low performance developmental quotients <70 at 18 and 36 months corrected age) outcomes on days on NCPAP and HFNC was assessed using the general linear model. 

Results: The data from 252 VLBWIs (28.9 ± 3.4 weeks gestation and 1049 ± 315g at birth, mean ± SD) were assessed. Longer days on HFNC (but not on NCPAP) were associated with shorter hospital stay (p=0.022), and earlier commencement and establishment of oral feeding (both p<0.001). Early commencement and establishment of oral feeding were also associated with higher developmental quotients at 18 and 36 months corrected age (both p<0.001).

Conclusions: The use of HFNC was associated with shorter hospital stay, and earlier commencement and establishment of oral feeding in VLBWIs. Our findings may warrant further prospective studies to elucidate the benefit of HFNC in promoting long term outcomes of VLBWIs.

Acknowledgement: We sincerely thank Dr. Takehiko Yokoyama, Dr. Takako Hirooka, Dr. Kaori Maruwaka, Dr. Satoko Fukaya, Dr. Syunsuke Nagara, Dr. Atsuko Kuroki, and Dr. Kentaro Ueda, for their great assistance.

HEATED HUMIDIFIED HIGH FLOW NASAL CANNULA IN VERY-LOW BIRTH WEIGHT INFANTS: POTENTIAL BENEFIT IN PROMOTING ORAL FEEDING AND EARLY HOSPITAL DIACHARGE