Type of noninvasive respiratory support, NCPAP or HHHFNC, does not impact feeding tolerance in preterm infants: JAMA
Italy: A recent study published in JAMA Network Open has suggested no direct influence of the type of noninvasive respiratory support on feeding tolerance in preterm infants.
The ENTARES randomized controlled trial comprised 247 preterm infants with respiratory distress. The authors randomized them to either the nasal continuous positive airway pressure (NCPAP) or heated humidified high-flow nasal cannula (HHHFNC). They observed no differences in the median time to achieve enteral feeding (14 days in both groups) or in the evaluation of the signs of feeding intolerance. However in the NCPAP group, they observed a better respiratory outcome.
Feeding intolerance and respiratory distress are common conditions that are often associated with preterm infants. The most noninvasive respiratory support (NRS) in neonatal intensive care units (ICUs) are HHHFNC and NCPAP, showing similar efficacy, but there is no information on their effect on feeding intolerance. To fill this knowledge gap, Francesco Cresi, University of Turin, Turin, Italy, and colleagues aimed to determine the effect of nasal continuous positive airway pressure versus heated humidified high-flow nasal cannula on high-risk preterm infants with respiratory distress syndrome.
The multicenter RCT comprised infants born in 1 of 13 neonatal ICUs in Italy between 2018 and 2021. The study enrolled two-hundred forty-seven infants (median gestational age, 28 weeks; 52.6% were girls), who were suitable for entral feeding and who proved to be medically stable on noninvasive respiratory support for at least 48 hours. They were randomized to receive either NCPAP (n = 122) or HHHFNC (n = 125).
The time to full enteral feeding (FEF), defined as an enteral intake of 150 mL/kg per day was determined as the study's primary outcome. secondary outcomes included signs of feeding intolerance, median daily increment of enteral feeding, peripheral oxygen saturation (SpO2)–fraction of inspired oxygen (FIO2) ratio at changes of NRS, effectiveness of the assigned NRS, and growth.
The study revealed the following findings:
- There were no differences in the primary and secondary nutritional outcomes between the 2 groups.
- The median time to reach FEF was 14 days in the NCPAP group and 14 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, 4.6 versus 3.7) and lower rate of ineffectiveness (4.8% versus 73.9%) were observed in the NCPAP vs HHHFNC group.
"We found that despite different working mechanisms, NCPAP and HHHFNC had similar effects on feeding intolerance, although some short-term respiratory outcomes were found to be better with NCPAP," the researchers wrote. "Clinicians may tailor respiratory care by selecting and switching between the 2 NRS techniques based on patient compliance and respiratory effectiveness, 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
