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Increased Use of Heated Humidified High Flow Nasal Cannula is Associated with Increased Chronic Lung Disease and Admission Time

Presented at the Neonatal Society 2017 Summer Meeting (programme).

Heath Jeffery RC1, Broom M2, Shadbolt B1,3, Bajuk B4, Todd DA1,2

1 Australian National University Medical School, Canberra, Australian Capital Territory (ACT) Australia
2 Department of Neonatology, Centenary Hospital, Canberra, ACT, Australia
3 Centre for Advances in Epidemiology and IT, Canberra, ACT, Australia
4 New South Wales (NSW) Pregnancy and Newborn Services Network, Sydney Children’s Hospitals Network, Randwick, Australia

Background: Over the past 5-10 years there has been an increased usage of HFNC in premature babies (PBs) together with an associated increase in CLD (1). The aims of this study are to compare the use of HFNC in NSW and the ACT over a 7year period in PBs <30 weeks gestational age (GA) and assess their outcomes.

Methods: This study compared prospectively collected data on surviving PBs <30 weeks GA from NSW and ACT (NICUS database) between 2009 and 2015. Comparisons were undertaken between those who did and did not receive HFNC. We first divided the data into two epochs to follow trend (1/1/09-30/6/12[E1] and 1/7/12- 31/12/15[E2]), then used the whole data to compare outcomes. Data were analysed using Un-paired t-tests, Chi Square and multivariate analysis.

Results: There were 3119 PBs eligible for analysis. Results highlighted a significant increase in HFNC usage from E1 to E2 (619/1547[40.0%] Vs 1151/1572[73.2%] p=0.0001, respectively). Baseline characteristics showed a significant differences between those who did or did not receive HFNC from E1 to E2 (GA:E1;26.9±1.5 Vs 27.6±1.5 Weeks±1SD, p=0.0001: E2;27.1±1.6 Vs 27.9±1.3, p=0.0001: Birthweight:E1;990±260 Vs 1185±274 grams±1SD, p=0.0001, E2;1009±257 Vs 1158±267, p=0.0001, respectively). Similarly, in the whole data, PBs who received HFNC were of significantly lower GA and BWt. CLD and corrected GA at discharge (CGAD) were significantly higher and longer in the PBs who received HFNC (CLD 831/1770 (46.9%) Vs 297/1349 (22.0%), p <0.0001, CGAD 39.9 ± 5.8 Vs 38.2 ± 3.0 weeks, p<0.001 respectively).

Conclusion: There has been an increase in HFNC usage in PBs <30 weeks GA. In PBs managed with HFNC there have been higher rates of CLD and longer admission times. The use of HFNC in PBs needs to be addressed.

Corresponding author:,

1. Heath Jeffery RC and Todd DA. Heated Humidified High-Flow Nasal Cannula: Impact on Neonatal Outcomes. Respiratory Care 2016;16 (10): 1428-1429

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