ObjectiveTo explore the clinical effect of heated humidified high flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (nCPAP) in the treatment of premature infants with respiratory distress syndrome (RDS).

MethodsA multicenter, prospective, randomized controlled clinical study was carried out. Two hundred and sixty premature infants diagnosed with RDS requiring non-invasive respiratory support in three treatment centers were included in the study. According to the body mass, the infants were divided into the body mass ≤1 500 g group (n=120) and body mass >1 500 g group(n=140), then the two groups were randomly subdivided into the HHHFNC group and nCPAP group. The primary observation indexes (treatment failure rate, re-intubation rate, hospital mortality rate, non-invasive ventilation time and oxygen use time) and the secondary observation indexes the incidence of nasal injury, abdominal distension, pulmonary air leakage, grade Ⅲ-Ⅳ intra-ventricular hemorrhage (IVH) and sepsis were compared among the groups.

ResultsAs for the primary observation indexes, in the body mass ≤1 500 g group, the non-invasive ventilation time and oxygen use time in the HHHFNC group were significantly higher than those in the nCPAP group (P < 0.01), and there were no significant differences in the treatment failure rate, hospital mortality rate and re-intubation rate between the two groups (P>0.05);in the body mass >1 500 g group, there were no significant differences in the treatment failure rate, non-invasive ventilation time, oxygen use time, hospital mortality rate and re-intubation rate between the HHHFNC group and nCPAP group (P>0.05). As for the secondary observation indexes, in the body mass ≤1 500 g group, the incidence of nasal injury and abdominal distension in the HHHFNC group were significantly lower than those in the nCPAP group (P < 0.01), and there were no significant differences in the incidence of pulmonary air leakage, grade Ⅲ-Ⅳ IVH and sepsis between the two groups (P>0.05);in the body mass >1 500 g group, the incidence of nasal injury in the HHHFNC group was significantly lower than that in the nCPAP group (P < 0.01), and there were no significant differences in the incidence of abdominal distension, pulmonary air leakage, grade Ⅲ-Ⅳ IVH and sepsis between the two groups (P>0.05).

ConclusionsHHHFNC can be used as the preferred respiratory support mode for mild to moderate RDS in preterm infants with body mass >1 500 g.