Comparison of Nasal Continuous Positive Airway Pressure and Heated Humidified High Flow Nasal Cannula in Premature Neonates with Respiratory Distress Syndrome

Authors

Fatima Tahira Services Insitute of Medical Sciences Lahore
Riffat Omer Services Insitute of Medical Sciences Lahore
Azhar Farooq Services Insitute of Medical Sciences Lahore
Adeel Masood Services Insitute of Medical Sciences Lahore
Sikander Ikram Services Insitute of Medical Sciences Lahore
Rani Saba Services Insitute of Medical Sciences Lahore

DOI:

https://doi.org/10.51273/esc25.251321115

Abstract

Abstract
Objective: To compare the clinical efficacy and safety of nasal continuous positive airway pressure (NCPAP)
and heated humidified high-flow nasal cannula (HHHFNC) as primary respiratory support modalities for
preterm neonates with respiratory distress.
Material and Methods: This comparative study was conducted at Department of Pediatrics Unit II, Services
Hospital, Lahore. It is a public sector tertiary care hospital. This comparative study included 74 preterm
neonates diagnosed with respiratory distress syndrome (RDS), allocated into two groups: NCPAP (n = 34)
and HHHFNC (n = 40). Data on key clinical parameters such as respiratory rate, cyanosis relief, apnea, and
mortality were recorded. Complications including necrotizing enterocolitis (NEC), sepsis, and shock were
also assessed. Quantitative variables were analyzed using independent t-tests, while qualitative variables
were compared using chi-square tests.
Results: Both NCPAP and HHHFNC demonstrated efficacy in stabilizing neonates. Mortality rates were low
and comparable between groups (NCPAP: 5.9%, HHHFNC: 2.5%; p>0.05). Severe RDS was more frequent
in the HHHFNC group (12.5%) compared to NCPAP (5.9%; p>0.05). NEC occurred exclusively in the
NCPAP group (11.8%; p =0.03), indicating a significant safety advantage with HHHFNC. Respiratory rates
were higher in the HHHFNC group (82.1±12.5) versus NCPAP (75.4±10.2;p=0.02). Additionally, HHHFNC
was superior in relieving cyanosis, achieving an 80.0% success rate compared to 32.4% with NCPAP (p<
0.05).
Conclusion: HHHFNC is an effective alternative to NCPAP for preterm neonates with respiratory distress. It
offers advantages such as reduced NEC rates, better oxygenation management, and support for severe RDS
cases. These findings support the inclusion of HHHFNC in neonatal care protocols, particularly in resource
constrained settings.
Keywords: Respiratory Distress Syndrome, Neonates, NCPAP, HHHFNC, Necrotizing Enterocolitis,
Neonatal Care.
How to cite: Tahira F, Omer R, Farooq A, Masood A, Ikram S, Saba R. Comparison of Nasal Continuous Positive
Airway Pressure and Heated Humidified High Flow Nasal Cannula in Premature Neonates with Respiratory Distress
Syndrome. Esculapio - JSIMS 2025;21(01): 80-85
DOI: https://doi.org/10.51273/esc25.251321115

References

Hug L, Alexander M, You D, Alkema L. National,

regional, and global levels and trends in neonatal

mortality between 1990 and 2017, with scenario

based projections to 2030: a systematic analysis.

Lancet Glob Health. 2019;7(6):710–20. DOI:

1016/S2214-109X(19)30163-9.

Lawn JE, Blencowe H, Oza S, et al. Every Newborn:

progress, priorities, and potential beyond survival.

Lancet. 2014;384(9938):189–205. DOI:

1016/S0140-6736(14)60496-7.

Raju TNK, Higgins RD, Stark AR, Leveno KJ.

Optimizing care and outcome for late-preterm (near

term) infants: a summary of the workshop sponsored

by the National Institute of Child Health and Human

Development. Pediatrics. 2006;118(3):1207–14.

DOI: 10.1542/peds.2006-0018.

Sweet DG, Carnielli V, Greisen G, et al. European

Consensus Guidelines on the Management of

Respiratory Distress Syndrome – 2019 Update.

Neonatology. 2019;115(4):432–50. DOI:

1159/000499361.

Aynalem YA, Mekonen H, Akalu TY, et al. Incidence

of respiratory distress and its predictors among

neonates admitted to neonatal intensive care units of

public hospitals in Ethiopia: a prospective cohort

study. BMC Pediatr. 2020;20(1):1–9. DOI:

1186/s12887-020-02337-4.

Liu L, Oza S, Hogan D, et al. Global, regional, and

national causes of under-5 mortality in 2000–15: an

updated systematic analysis with implications for the

Sustainable Development Goals. Lancet.

;388(10063):3027–35. DOI: 10.1016/S0140

(16)31593-8.

Chawanpaiboon S, Vogel JP, Moller AB, et al. Global,

regional, and national estimates of levels of preterm

birth in 2014: a systematic review and modelling

analysis. Lancet Glob Health. 2019;7(1):e37–46.

DOI: 10.1016/S2214-109X(18)30451-0.

Kc A, Wrammert J, Clark RB, et al. Reducing

perinatal mortality in Nepal using helping babies

breathe. Pediatrics. 2016;137(6):e20150117. DOI:

1542/peds.2015-0117.

Koyamaibole L, Kado J, Qovu JD, et al. An

evaluation of bubble-CPAP in a neonatal unit in a

developing country: effective respiratory support that

can be applied by nurses. J Trop Pediatr.

;52(4):249–53. DOI: 10.1093/tropej/fml017.

Wilkinson D, Andersen C, O'Donnell CP, De Paoli

AG. High flow nasal cannula for respiratory support

in preterm infants. Cochrane Database Syst Rev.

0 1 6 ; 2 ( 2 ) : C D 0 0 6 4 0 5 . D O I :

1002/14651858.CD006405.pub3.

Shoemaker MT, Pierce MR, Yoder BA, DiGeronimo

RJ. High flow nasal cannula versus nasal CPAP for

neonatal respiratory disease: a retrospective study. J

Perinatol. 2007;27(2):85–91. DOI:

1038/sj.jp.7211647.

Jhou HJ, Chen PH, Lin C, et al. High-flow nasal

cannula therapy as apneic oxygenation during

endotracheal intubation in critically ill patients in the

intensive care unit: a systematic review and meta

analysis. Sci Rep. 2020;10:3541. DOI:

1038/s41598-020-60636-9.

Shin J, Park K, Lee EH, Choi BM. Humidified High

Flow Nasal Cannula versus Nasal Continuous

Positive Airway Pressure as an Initial Respiratory

Support in Preterm Infants with Respiratory Distress:

a Randomized, Controlled Non-Inferiority Trial. J

Korean Med Sci. 2017;32(4):650–55. DOI:

3346/jkms.2017.32.4.650.

Effectiveness of high flow nasal Cannula (HFNC)

therapy compared to standard oxygen therapy (SOT)

and continuous positive airway pressure (CPAP) in

bronchiolitis. Pediatr Respir Rev. 2024. DOI:

1016/j.prrv.2024.05.004.

Balhareth Y, Razak A. High Flow Nasal Cannula for

Weaning Nasal Continuous Positive Airway Pressure

in Preterm Infants: A Systematic Review and Meta

Analysis. Neonatology. 2024;121(3):359–69. DOI:

1159/000536464.

Murphy T, Beringer R. Comments on Elmitwalli et al

'Use of high-flow nasal cannula versus other

noninvasive ventilation techniques or conventional

oxygen therapy for respiratory support after pediatric

cardiac surgery: A systematic review and meta

analysis'. Pediatr Anesth. 2024;34(12):1282–83.

DOI: 10.1111/pan.14966

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Published

2025-03-31

How to Cite

Fatima Tahira, Riffat Omer, Azhar Farooq, Adeel Masood, Sikander Ikram, Rani Saba. Comparison of Nasal Continuous Positive Airway Pressure and Heated Humidified High Flow Nasal Cannula in Premature Neonates with Respiratory Distress Syndrome. Esculapio - JSIMS [Internet]. 2025 Mar. 31 [cited 2025 May 13];21(1):80-5. Available from: https://esculapio.pk/journal/index.php/journal-files/article/view/1417