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Heated Humidified High-Flow Nasal Cannula for Preterm Infants: An Updated Systematic Review and Meta-analysis

Published online by Cambridge University Press:  11 July 2019

Nigel Fleeman ,
Yenal Dundar Open the ORCID record for Yenal Dundar [Opens in a new window] ,
Prakesh S Shah  and
Ben NJ Shaw
Nigel Fleeman*
Affiliation:
Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
Yenal Dundar
Affiliation:
Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom Mersey Care NHS Foundation Trust, Liverpool, United Kingdom
Prakesh S Shah
Affiliation:
Departments of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, Canada
Ben NJ Shaw
Affiliation:
Neonatal Unit, Liverpool Women’s NHS Foundation Trust, Liverpool, United Kingdom
*
Author for correspondence: Nigel Fleeman, E-mail: [email protected]
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Abstract

Background

Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as a mode of respiratory support. We updated a systematic review and meta-analyses examining the efficacy and safety of HHHFNC compared with standard treatments for preterm infants. The primary outcome was the need for reintubation for preterm infants following mechanical ventilation (post-extubation analysis) or need for intubation for preterm infants not previously intubated (analysis of primary respiratory support)

Methods

We searched PubMed, MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of HHHFNC versus standard treatments. Meta-analysis was conducted using Review Manager 5.3.

Results

The post-extubation analysis included ten RCTs (n = 1,201), and the analysis of primary respiratory support included ten RCTs (n = 1,676). There were no statistically significant differences for outcomes measuring efficacy, including the primary outcome. There were statistically significant differences favoring HHHFNC versus nasal cannula positive airway pressure (NCPAP) for air leak (post-extubation, risk ratio [RR] 0.29, 95 percent confidence interval [CI] 0.11 to 0.76, I2 = 0) and nasal trauma (post-extubation: 0.35, 95 percent CI 0.27 to 0.46, I2 = 5 percent; primary respiratory support: RR 0.52, 95 percent CI 0.37 to 0.74; I2 = 27 percent). Studies, particularly those of primary respiratory support, included very few preterm infants with gestational age (GA) <28 weeks.

Conclusions

HHHFNC may offer an efficacious and safe alternative to NCPAP for some infants but evidence is lacking for preterm infants with GA ≤28 weeks.

Keywords

PretermHeated-humidified high-flow nasal cannulaSystematic reviewMeta-analysis
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 4 , 2019 , pp. 298 - 306
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Thank you to all our co-authors of the original review. Thanks also to Dr. Rabeea'h Aslam who assisted with the selection of studies for the updated review and Miss Marty Richardson who provided statistical advice regarding the updated meta-analyses.

Funding source: This project was originally funded by the National Institute for Health Research Health Technology Assessment Programme (project number 14/151/03). See the Health Technology Assessment programme website for further project information: http://www.nets.nihr.ac.uk/programmes/hta. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the National Institute for Health and Care Excellence or the Department of Health Financial disclosure: The authors have no financial relationships relevant to this article to disclose. Study registration: The original review is registered as PROSPERO CRD42015015978. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=15978

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