Safety and efficacy of high-flow nasal cannula therapy in preterm infants: A systematic review and meta-analysis

Introduction: High-flow therapy is the most recent mode of respiratory support in neonates, which has become popular on neonatal units without robust supporting evidence. Objectives: We conducted a systematic review of all clinical trials comparing efficacy and safety of high-flow therapy with other modes of non-invasive ventilation, with a view to pooling relevant data into a meta-analysis. Methods: Indexed articles were searched for randomised or quasi-randomised clinical trials involving preterm infants, comparing high-flow therapy with other modes of non-invasive ventilation, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety and other common neonatal outcomes were extracted on pre-designed data extraction forms. Results: Seven full-text articles and two abstracts, involving 1112 preterm infants, were included in the final analysis. Majority of included infants were moderate to late preterms (> 28 weeks gestational age at birth). High-flow therapy was similar in efficacy to other modes of non-invasive ventilation in preterm infants (odds ratio of failure 1.10; 95% confidence interval 0.82 – 1.49), although there was a trend towards lower odds of death (0.48; 0.18 – 1.24) and air leaks (0.72; 0.28 – 1.83). Preterm infants supported on high-flow had significantly lower odds of nasal trauma (0.13; 0.02 – 0.69). Other neonatal outcomes were comparable between the groups. Conclusions: High-flow therapy could be the preferred mode of respiratory support for moderate to late preterm infants, due to equivalent efficacy and safety with better adverse effect profile.