Effectiveness of Humidified High Flow Nasal Cannula Versus Continuous Nasal Positive Airway Pressure in Managing Respiratory Failure in Preterm Infants: An Emergency Department Study

Background: The HHFNC is routinely utilised as a non-invasive respiratory support for preterm infants with respiratory distress; few studies have compared it to nCPAP for the first treatment of respiratory distress in preterm neonates. This study aims to compare the effectiveness and outcomes of HHFNC and nCPAP in improving respiratory outcomes and reducing adverse effects. Methods: The 220 patients from the neonatal unit enrolled in the study (110 in each group) after obtaining written informed consent from their parents/guardians. Nasal CPAP was applied to patients in group A through a nasal mask with the following settings: FiO2: 40–60%, PEEP: 5–8 cm H2O, flow: 4–6 L/min. HHFNC was initiated at 5 L/min and adjusted between 3–7 L/min based on respiratory status, with FiO2 starting at 0.4 and modified to maintain SPO2; between 88–94%. Study variables were recorded and analysed using SPSS version 23.0. Results: The comparison of nCPAP (Group A) and HHFNC (Group B) showed no significant differences in age, gestational age, or clinical parameters, except for a higher respiratory rate in HHFNC. The HHFNC group had significantly shorter durations of non-invasive ventilator support and hospital stay. Adverse effects were more common in HHFNC, especially nasal mucosal injury, while sepsis was more frequent in nCPAP. Treatment failure occurred more often in the HHFNC group. Neonatal outcomes were similar, with no significant differences in discharge without the need for intubation rates, mortality, or intubation rates. Conclusions: The HHFNC is associated with a shorter duration of non-invasive ventilatory support and hospital stay compared to nCPAP. However, nCPAP demonstrated a significant survival advantage and a lower risk of treatment failure. Both modalities are effective in supporting preterm neonates with respiratory distress, but clinical considerations should guide the choice of therapy. Further research is necessary to confirm these findings and explore strategies to optimize outcomes and mitigate adverse effects associated with each modality.