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Changes in lung aeration with high-flow nasal cannula compared to nasal CPAP in preterm infants

Abstract

Objective

To compare the degree of atelectasis in preterm infants on nasal continuous airway pressure (nCPAP) versus high-flow nasal cannula (HFNC) at 8 L/min.

Study Design

A cross-over study of infants <29 weeks gestational age (GA) receiving nCPAP and underwent 6-hours of HFNC at 8 L/min before returning to nCPAP. Electrical Impedance Tomography was used to measure lung aeration.

Results

78 infants with median GA of 27 weeks [26, 28] were studied. HFNC was non-inferior to CPAP across the 4 periods (overall mean 2.1 ± 2.9, lower bound of confidence interval −0.9). Infants that failed HFNC had higher dependent silent spaces (DSS) measurements (1.6[0.48, 4.7] vs 0.30[0.0, 2.7], P = 0.046).

Conclusion

This study of premature infants <29 weeks GA at birth demonstrated that HFNC was non-inferior to nCPAP as measured by DSS. Infants that failed HFNC had a higher percentage of DSS than those who tolerated HFNC for 6 hours suggesting decreased lung aeration.

ClinicalTrials.gov ID: NCT03700606

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Fig. 1: Ibex EIT Image Analysis of HFNC Pass vs. Fail Infant.
Fig. 2: Flowchart.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to acknowledge the help from EIT experts David Tingay, Inéz Frerichs, Andreas Waldmann, and Antoine Dupré. The support of the Research Associates and the Respiratory Therapists at Sharp Mary Birch Hospital for Women & Newborns whose support was critical in completing this study. Also thank you to the parents and families of our participants for allowing us to conduct this important research.

Funding

Research reported in this publication was supported by an unrestricted grant from Fisher and Paykel Healthcare. Fisher and Paykel Healthcare did not influence the study design, data collection, analysis, interpretation, writing, or decision to send the manuscript for publication.

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Authors and Affiliations

Authors

Contributions

Dr. Katheria: Conceptualized, Methodology, Data Curation, Validation, Writing—Original Draft, Supervision, and approved the final manuscript as submitted. Mr. Rich, Mr. Ines, and Ms. Morales: Methodology, Data Curation, Writing—Review & Editing the manuscript, and approved the final manuscript as submitted. Mr. Sanjay: Data Curation, Visualization, Software, and approved the final manuscript as submitted. Dr. Finer, Dr. Poeltler, and Dr. Hough: Formal analysis and interpretation of data, Validation, Writing—Review & Editing, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Anup Katheria.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Approval was obtained from Sharp HealthCare Institutional Review Board under IRB#1807906. Consent was obtained from all participants and the study was performed in accordance with the Declaration of Helsinki.

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Katheria, A., Ines, F., Hough, J. et al. Changes in lung aeration with high-flow nasal cannula compared to nasal CPAP in preterm infants. J Perinatol 45, 817–822 (2025). https://doi.org/10.1038/s41372-025-02267-4

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