Question 2: Humidified heated high flow nasal cannula versus nasal continuous positive airway pressure for providing respiratory support following extubation in preterm newborns

On the morning ward round, you review a 27-week gestational age neonate who is ready for extubation following a brief period of mechanical ventilation for respiratory distress syndrome. Your neonatal unit has recently introduced humidified heated high flow nasal cannula (HHHFNC) as a means of providing non-invasive respiratory support. You wonder about the risk of failed extubation compared with standard nasal continuous positive airway pressure (nCPAP). The medical student on the ward round also asks you whether there would be any difference in the risk of the baby developing bronchopulmonary dysplasia (BPD) between these two modes of respiratory support. In a preterm neonate who is ready for extubation following a period of mechanical ventilation, is HHHFNC inferior to nCPAP for the respiratory outcomes of extubation failure and BPD? Randomised trials reporting the incidence of extubation failure or BPD in preterm neonates extubated to HHHFNC compared with nCPAP were to be included. ### Secondary sources Searching the Cochrane library with the terms ‘newborn high flow nasal’ returned three results, one of which was relevant.1 Using the terms ‘infant high flow nasal’ returned six results with no further relevant articles. From the single relevant Cochrane review identified, one randomised controlled trial (RCT) was reviewed in full …