Heated, humidified high-flow nasal cannula vs. nasal CPAP in infants with moderate respiratory distress

Background Respiratory distress is the most common cause of morbidity in premature babies in the delivery room. Nasal continuous positive airway pressure (nCPAP) is widely used as the preferred modality of treatment, although it may cause nasal trauma. Heated, humidified high-flow nasal (HHHFN) cannula is an alternative oxygen therapy, yet the safety and efficacy has not been widely studied. Objective To compare the safety and efficacy of HHHFN and nCPAP in premature babies with gestational age > 28 to < 35 weeks and moderate respiratory distress. Methods We conducted a randomized, non-inferiority, clinical trial using HHHFN vs. nCPAP as a treatment for moderate respiratory distress within 72 hours after they had been used. The efficacy endpoints were treatment failure, length of device use, length of Kangaroo Mother Care (KMC), and full enteral feeding time. Safety assessment included pain score, nasal trauma, and systemic complications. Results No differences were found in terms of incidence of endotracheal intubation within < 72 hours of HHHFN (20%) compared to nCPAP (18%) (P=0.799). However, there was a significant difference in moderate nasal trauma in nCPAP (14%) compared to HHHFN (0%)(P=0.006). There were no significant differences of blood gas analysis results, full enteral feeding time, length of KMC, length of device use, and rate of complications (bronchopulmonary dysplasia/BPD, intraventricular hemorrhage/IVH, patent ductus arteriosus/PDA, necrotizing enterocolitis/NEC and late onset neonatal sepsis/LONS) between the nCPAP and HHHFN groups. Conclusion The HHHFN is not inferior to nCPAP in terms of the safety and efficacy as primary non-invasive therapy in premature babies of gestational age > 28 to < 35 weeks with moderate respiratory distress . Compared to nCPAP, HHHFN induced lower nasal trauma.

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Clinical and X-ray Diagnosis of Respiratory Distress in Premature Babies of Less than 34-Week Gestational Age

General Reanimatology ◽

10.15360/1813-9779-2005-5-28-33 ◽

2005 ◽

Vol 1 (5) ◽

pp. 28

Author(s):

N. N. Volodin ◽

D. N. Degtyarev ◽

I. Ye Kotik ◽

I. S. Ivanova

Keyword(s):

Respiratory Distress ◽

Gestational Age ◽

X Ray ◽

Premature Babies

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Oropharyngeal Administration of Colostrum for Preventing Necrotizing Enterocolitis and Late-onset Sepsis in Preterm Infants with Gestational Age ≤ 32 Weeks: A Single-center Randomized Controlled Trial

10.21203/rs.3.rs-145820/v1 ◽

2021 ◽

Author(s):

xia ouyang ◽

changyi yang ◽

wenlong xiu ◽

yanhua hu ◽

susu mei ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Enteral Feeding ◽

Gestational Age ◽

Late Onset ◽

Controlled Trial ◽

Control Group ◽

Clinical Trial Registry ◽

Late Onset Sepsis ◽

Full Enteral Feeding

Abstract BackgroundOropharyngeal administration of colostrum (OAC) may provide immunoprotective and anti-inflammatory effects that potentially reduce the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) and improve short-term outcomes.ObjectiveTo evaluate the role of OAC in the early prevention of NEC and LOS in preterm infants with gestational age (GA) ≤ 32 weeks.MethodsA randomized, placebo-controlled trial was conducted in a 40-bed tertiary neonatal intensive care unit (NICU) in China. Preterm infants with GA ≤ 32 weeks were divided randomly into an OAC group, which received 0.4 ml maternal colostrum smearing via the oropharyngeal route every 3 hours for 10 days beginning within the first 48 hours after birth, and a control group, which received normal saline instead. Data from the two groups were collected and compared.ResultsA total of 127 patients in the OAC group and 125 patients in the control group were finally enrolled. The incidence of NEC (Bell stage 2 or 3) and LOS was lower in the OAC group [2.4% vs. 10.4%, χ2 = 6.845, ༰=0.009; 4.7% vs. 13.6%, χ2 = 5.983, ༰=0.014]. In addition, the incidence of intraventricular hemorrhage (IVH) (stage 3 or 4) was lower [1.6% vs. 7.2%,χ2 = 4.775, ༰=0.029], and the time of achieving full enteral feeding was shorter [ 22.0 days vs. 25.0 days༌Z = 6༌424.500༌P = 0.009)] in the OAC group. No cases of adverse reactions were observed in either group.ConclusionsOAC is a safe and simple NICU procedure that yields a potential advantage in decreasing the incidence of NEC, LOS, and severe IVH and shortening the time to achieve full enteral feeding in preterm infants with GA ≤ 32 weeks.Trial registrationChinese Clinical Trial Registry, ChiCTR1900023697, Registered 8 June 2019, Retrospectively registered, http://www.chictr.org.cn/edit.aspx? pid = 39398

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The Effectiveness of the Heated Humidified High Flow Nasal Cannula as an Initial Noninvasive Respiratory Support for Preterm Infants Suffering from Respiratory Distress

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2130690 ◽

2020 ◽

pp. 1-13

Author(s):

Sarah Mohamed Nofal ◽

May Rabie El- Sheikh ◽

Heba Saed El- Mahdy ◽

Mostafa Mohamed Awny

Keyword(s):

Birth Weight ◽

Respiratory Distress ◽

Preterm Infants ◽

Median Duration ◽

Flow Rate ◽

High Flow ◽

Respiratory Support ◽

High Flow Nasal Cannula ◽

Flow Rates ◽

Nasal Trauma

Aims: to compare the efficacy and safety of the heated humidified high-flow nasal cannula as a noninvasive respiratory support for the initial management of respiratory distress in preterm infants ≥ 30 weeks gestation with birth weight ≥ 1300 g at different flow rates (3 L/min and 6 L/min) on admission. Study Design: A Randomized controlled trial. Place and Duration of Study: Neonatal Intensive Care Unit, Pediatrics department, Tanta University Hospitals, over one-year period, from December 2018 to December 2019. Methodology: 30 preterm neonates, with gestational ages ranged between 30 to 36 weeks and birth weight ≥ 1300 g, were randomized to receive HHHFNC at either flow rate 3 or 6 L\min as an initial respiratory support. Primary outcomes included: the incidence of treatment failure of the HHHFNC at flow 3 L/min and 6 L/min, which will require n CPAP or NIMV, or will require intubation. Secondary outcomes included: rate of deaths at any time after randomization, the total duration of all types of oxygen support and incidence of neonatal morbidities such as nasal trauma, symptomatic patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH ≥ grade II), pneumothorax, pulmonary hemorrhage, retinopathy of prematurity (ROP), apnea, sepsis and necrotizing enterocolitis (NEC ≥ stage II). Results: the incidence of the need for higher flow rate of HHHFNC (n=11, 36.6%) , the need for n CPAP or NIMV after failure of higher flow rate of HHHFNC (n=11, 36.6%), the need for intubation & MV (n=1, 3.3%), the incidence of nasal trauma (n=7, 23.3%), BPD (n=0) , IVH ≥ II (n=0), NEC ≥II (n=0), pneumothorax (n=0) , the median duration of hospitalization =10 days (7-15), the median duration of all oxygen support = 6.5 days (6-7). The failure rate was 11 out of 30 infants (36.6%), no deaths or pulmonary haemorrhage. Conclusion: HHHFNC use shows similar rates of efﬁcacy to other forms of noninvasive respiratory support in preterm infants with respiratory distress for initial respiratory support with lesser complications. There were better outcomes with higher gestational age and birth weight at either flow rates 3 or 6 L/min.

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Achievement of full enteral feeding using volume advancement in infants with birth weight 1,000 to <2,000 grams

Paediatrica Indonesiana ◽

10.14238/pi60.4.2020.173-7 ◽

2020 ◽

Vol 60 (4) ◽

pp. 173-7

Author(s):

Teti Hendrayanti ◽

Afifa Ramadanti ◽

Indrayady Indrayady ◽

Raden Muhammad Indra

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Enteral Feeding ◽

Gestational Age ◽

Very Low Birth Weight ◽

Hyaline Membrane Disease ◽

Related Factors ◽

Enteral Feedings ◽

And Gender ◽

Full Enteral Feeding

Background Early enteral feeding is one of the efforts to improve gastrointestinal adaptability in preterm infants. Volume advancement (VA) enteral feeding has been associated with less time to reach full feeding, which can improve outcomes. Objective To evaluate the duration of VA needed to achieve full enteral feeding (FEF) in low birth weight (LBW) and very low birth weight (VLBW) infants and related factors. Methods This prospective study was done in infants with birth weight 1,000 to <2,000 grams in the Neonatal Ward and NICU of Dr. Moh. Hoesin General Hospital, Palembang, South Sumatera. All infants underwent VA feeding. The time needed to achieve FEF (150 ml/kg/day) was recorded. Several clinical factors were analyzed for possible associations with the success rate of achieving FEF within 10 days of feeding. Results Thirty-five infants were included in this study with a mean gestational age of 31.83 (SD 2.67) weeks. Their median body weight at the start of protocol was 1,400 (range 1,000 – 1,950) grams and 80% had hyaline membrane disease. Median time to achieve FEF was 11 (range 8–21) days, with 48.6% subjects achieving FEF in ≤10 days. Gestational age <32 weeks (OR 5.404, 95%CI 0.963 to 30.341), birth weight <1,500 grams (OR 5.248, 95%CI 0.983 to 28.003), and male (OR 4.751, 95%CI 0.854 to 26.437) gender were associated with the failure of achieving FEF within 10 days of feeding, however, no factors remained statistically significant after multivariate analysis. Conclusion Full enteral feedings in infants with birth weight 1,000 to <2,000 grams with VA feeding are achieved within a median of 11 days. Gestational age, birth weight, and gender are not associated with time needed to achieve FEF.

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Cycled Lighting Versus Continuous Near Darkness in Preterm Infants: A Randomized Controlled Trial

Klinische Pädiatrie ◽

10.1055/a-1554-5699 ◽

2021 ◽

Author(s):

Sema Arayici ◽

Gulsum Kadioglu Simsek ◽

Nurdan Uras ◽

Mehmet Yekta Oncel ◽

Fuat Emre Canpolat ◽

...

Keyword(s):

Growth Hormone ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Preterm Infants ◽

Enteral Feeding ◽

Feeding Time ◽

Anthropometric Parameters ◽

Time Duration ◽

Serum Growth Hormone ◽

Full Enteral Feeding

ABSTRACT Objective To compare the effectiveness of cycled lighting (CL) or continuous near darkness (CND) on weight in preterm infants. Study Design Total 147 infants with a gestational age 25–32 weeks and/or a birth weight 750–1500 g were included in the study. The infants were classified into two groups: CL and CND. Weight on postnatal day 14, weight at corrected 35 weeks, mean rectal temperature and serum growth hormone, cortisol, melatonin levels at 35 weeks’ post menstrual age (PMA), weekly weight gain, full enteral feeding time, duration of mechanical ventilation, retinopathy of prematurity (ROP), length of stay in the hospital, weight and length at three and six months corrected age were compared between the groups. Results There were no differences between weights on postnatal day 14. Anthropometric parameters and mean rectal temperatures of groups also were not different at 35 weeks’ PMA. There were no differences among the groups in duration of full enteral feeding time, length of stay in hospitalization, duration of mechanical ventilation, ROP and anthropometric parameters. Further, serum growth hormone, cortisol, and melatonin levels were similar between the groups at 35 weeks’ PMA. Conclusion CL and CND did not have any advantages over each other.

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Early full enteral feeding for preterm or low birth weight infants

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013542.pub2 ◽

2020 ◽

Author(s):

Verena Walsh ◽

Jennifer Valeska Elli Brown ◽

Bethany R Copperthwaite ◽

Sam J Oddie ◽

William McGuire

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Enteral Feeding ◽

Low Birth Weight Infants ◽

Full Enteral Feeding

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Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

American Journal of Perinatology ◽

10.1055/s-0041-1722942 ◽

2021 ◽

Author(s):

Erbu Yarci ◽

Fuat E. Canpolat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Respiratory Diseases ◽

Respiratory Disorders ◽

Live Births

Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

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Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis

Annals of Nutrition and Metabolism ◽

10.1159/000516640 ◽

2021 ◽

pp. 1-17

Author(s):

Viraraghavan Vadakkencherry Ramaswamy ◽

Tapas Bandyopadhyay ◽

Javed Ahmed ◽

Prathik Bandiya ◽

Sanja Zivanovic ◽

...

Keyword(s):

Enteral Feeding ◽

Primary Outcome ◽

Meta Analysis ◽

Credible Interval ◽

Stage Ii ◽

Preterm Neonates ◽

Feeding Strategies ◽

Moderate Volume ◽

Full Enteral Feeding ◽

Critical Aspects

Introduction: Critical aspects of time of feed initiation, advancement, and volume of feed increment in preterm neonates remain largely unanswered. Methods: Medline , Embase, CENTRAL and CINAHL were searched from inception until 25th September 2020. Network meta-analysis with the Bayesian approach was used. Randomized controlled trials (RCTs) evaluating preterm neonates ≤32 weeks were included. Feeding regimens were divided based on the following categories: initiation day: early (<72 h), moderately early (72 h–7 days), and late (>7 days); advancement day: early (<72 h), moderately early (72 h–7 days), and late (>7 days); increment volume: small volume (SV) (<20 mL/kg/day), moderate volume (MoV) (20–< 30 mL/kg/day), and large volume (≥30 mL/kg/day); and full enteral feeding from the first day. Sixteen regimens were evaluated. Combined outcome of necrotizing enterocolitis (NEC) stage ≥ II or mortality before discharge was the primary outcome. Results: A total of 39 studies enrolled around 6,982 neonates. Early initiation (EI) with moderately early or late advancement using MoV increment enteral feeding regimens appeared to be most efficacious in decreasing the risk of NEC or mortality when compared to EI and early advancement with SV increment (risk ratio [95% credible interval]: 0.39 [0.12, 0.95]; 0.34 [0.10, 0.86]) (GRADE–very low). Conclusions: Early initiated, moderately early, or late advanced with MoV increment feeding regimens might be most appropriate in decreasing the risk of NEC stage ≥II or mortality. In view of the certainty of evidence being very low, adequately powered RCTs evaluating these 2 strategies are warranted.

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