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

J Perinatol. 2025 Jun;45(6):817-822. doi: 10.1038/s41372-025-02267-4. Epub 2025 Mar 23.

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.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Cannula
  • Continuous Positive Airway Pressure* / adverse effects
  • Continuous Positive Airway Pressure* / methods
  • Cross-Over Studies
  • Electric Impedance
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Lung* / diagnostic imaging
  • Lung* / physiopathology
  • Male
  • Oxygen Inhalation Therapy* / instrumentation
  • Oxygen Inhalation Therapy* / methods
  • Pulmonary Atelectasis* / etiology
  • Respiratory Distress Syndrome, Newborn* / therapy
  • Tomography

Associated data

  • ClinicalTrials.gov/NCT03700606