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Lower gestational age predicts nasal high-flow treatment failure in preemies

07 May 2018

A lower gestational age (GA) and a higher FiO2 increase the likelihood of nasal high-flow (nHF) treatment failure in preterm infants born ≥28 weeks, a recent study has shown. Moreover, continuous positive airway pressure (CPAP) is still the superior early respiratory support procedure.

Infants who had successful nHF treatments had significantly higher GA (32.3±2.1 vs 31.1±1.9 weeks; odds ratio [OR], –1.3; 95 percent CI, –1.8 to –0.7; p<0.001) and lower supplemental oxygen concentration before randomization (21 percent vs 28 percent; p<0.001).

In comparison, those who experienced nHF failure vs success were significantly more likely to be singleton births (OR, 0.43; 0.24–0.79; p=0.006).

Analysis by GA showed that those who were born <30 weeks of gestation were significantly more likely to have treatment failure than their counterparts born ≥30 weeks of gestation (47.2 percent vs 20.4 percent; OR, 3.5; 1.9–6.5; p<0.001).

Similarly, those who showed an FiO2 ≥30 vs <0.30 were more likely to experience nHF failure (48.5 percent vs 18.1 percent; OR, 4.3; 2.4–7.7; p<0.001).

In addition, the multivariable model including decreasing GA and increasing FiO2 concentration before randomization was moderately predictive of nHF failure (area under the receiver operating characteristic curve, 0.76; 0.70–0.83).

For the study, researchers accessed data from the multicentre, randomized, noninferiority HIPSTER trial, which compared nHF with CPAP treatment as primary respiratory support in preterm infants.

Aside from determining risk factors for treatment failure, researchers also compared nHF with CPAP and found that, in the absence of both risk factors (ie, GA ≥30 weeks and FiO2 <0.30), rate of failure remained significantly lower with CPAP vs nHF (6.6 percent vs 15.7 percent; p=0.007).

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