Non invasive respiratory support like NCPAP and HHHFNC do not directly influence feeding tolerance in preterm infants

Respiratory distress syndrome (RDS) is a growing concerning in preterm infants. The use of noninvasive respiratory support (NRS) is most recommended as it reduces the need for mechanical ventilation, the risk of death, intraventricular hemorrhage, and bronchopulmonary dysplasia in these infants.

A recent randomized clinical trial ENTARES reported that Nasal Continuous Positive Airway Pressure (NCPAP) or Heated Humidified High-Flow Nasal Cannula (HHHFNC) arm, showed no much difference to achieve full enteral feeding or in the evaluation of the signs of feeding intolerance however respiratory outcome was better in the NCPAP group. The study is published in JAMA Network.

The researchers conducted a multicenter randomized clinical trial involved infants who were born in 1 of 13 neonatal intensive care units in Italy between November 1, 2018, and June 30, 2021. Preterm infants with a gestational age of 25 to 29 weeks, who were suitable for enteral feeding and who proved to be medically stable on NRS for at least 48 hours were enrolled in the study within the first week of life and randomized to receive either NCPAP or HHHFNC. The primary outcome was the time to full enteral feeding (FEF), defined as an enteral intake of 150 mL/kg per day. Secondary outcomes were the median daily increment of enteral feeding, signs of feeding intolerance, effectiveness of the assigned NRS, peripheral oxygen saturation (SpO2)–fraction of inspired oxygen (FIO2) ratio at changes of NRS, and growth.

The key findings of the study are

• A total of 247 infants (median [IQR] gestational age, 28 [27-29] weeks; 130 girls [52.6%]) were randomized to the NCPAP group (n = 122) or the HHHFNC group (n = 125).

• There were no differences in the primary and secondary nutritional outcomes between the 2 groups.

• The median time to reach FEF was 14 days (95% CI, 11-15 days) in the NCPAP group and 14 days (95% CI, 12-18 days) in the HHHFNC group, and similar results were observed in the subgroup of infants with less than 28 weeks’ gestation.

• On the first NRS change, higher SpO2–FIO2 ratio (median [IQR], 4.6 [4.1-4.7] vs 3.7 [3.2-4.0]; P < .001) and lower rate of ineffectiveness (1 [4.8%] vs 17 [73.9%]; P < .001) were observed in the NCPAP vs HHHFNC group.

Researchers concluded that “This randomized clinical trial found that NCPAP and HHHFNC had similar effects on feeding intolerance, despite different working mechanisms. Clinicians may tailor respiratory care by selecting and switching between the 2 NRS techniques on the basis of respiratory effectiveness and patient compliance, without affecting feeding intolerance.”

Reference: Cresi F, Maggiora E, Lista G, et al. Effect of Nasal Continuous Positive Airway Pressure vs Heated Humidified High-Flow Nasal Cannula on Feeding Intolerance in Preterm Infants With Respiratory Distress Syndrome: The ENTARES Randomized Clinical Trial. JAMA Netw Open. 2023;6(7):e2323052. doi:10.1001/jamanetworkopen.2023.23052