High-flow nasal cannulae in the management of apnea of prematurity: A comparison with conventional nasal continuous positive airway pressure

Apnea of prematurity (AOP) is frequently managed with nasal continuous posi tive airway pressure (NCPAP). Nasal cannula (NC) are used at low flows (< 0 .5 L/min) to deliver supplemental oxygen to neonates. A number of centers u se high-flow nasal cannula (HFNC) in the management of AOP without measurin g the positive distending pressure (PDP) generated. Objective. To determine the NC flow required to generate PDP equal to that provided by NCPAP at 6 cm H2O and to assess the effectiveness of HFNC as co mpared NCPAP in the management of AOP. Method. Forty premature infants, gestation 28.7 +/- 0.4 weeks (mean 6 stand ard error of mean), postconceptual age at study 30.3 +/- 0.6 weeks, birth w eight 1256 +/- 66 g, study weight 1260 +/- 63 g who were being managed with conventional NCPAP for at least 24 hours for clinically significant apnea of prematurity, were enrolled in a trial of ventilator-generated convention al NCPAP versus infant NC at flows of up to 2.5 L/min. End expiratory esoph ageal pressure was measured on NCPAP and on NC, and the gas flow on NC was adjusted to generate an end expiratory esophageal pressure equal to that me asured on NCPAP. Two 6-hour periods were continuously recorded and the data were stored on computer. Results. The flow required to generate a comparable PDP with NC varied with the infant's weight and was represented by the equation: flow (L/min) = 0. 92 + 0.68x, x = weight in kg, R = 0.72. There was no difference in the freq uency and duration of apnea, bradycardia or desaturation per recording betw een the 2 systems. Conclusion. NC at flows of 1 to 2.5 L/min can deliver PDP in premature neon ates. HFNC is as effective as NCPAP in the management of AOP.