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The effect of non-invasive high-frequency oscillatory ventilation on the duration of non-invasive respiratory support in late preterm and term infants with transient tachypnea of the newborn: a randomized controlled trial

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Abstract

Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34 weeks’ gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21 h [IQR: 16–68] for nHFOV vs 15 h [IQR: 11–33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3 h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications.

   Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN.

   Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016.

What is Known:

• nHFOV is a ventilation model that has been increasingly used for the management of RDS.

• TTN is one of the most common causes of neonatal respiratory distress.

What is New:

• nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support.

• nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN.

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Data availability

The corresponding author can provide the data supporting this study upon reasonable request, providing patient data privacy is not violated.

Abbreviations

C/S:

Cesarean section

FiO2 :

Fractional inspired oxygen

GA:

Gestational age

nCPAP:

Nasal continuous positive airway pressure

nHFOV:

Non-invasive high-frequency oscillatory ventilation

NICU:

Neonatal intensive care units

nIMV:

Nasal intermittent mandatory ventilation

RDS:

Respiratory distress syndrome

TTN:

Transient tachypnea of the newborn

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Dortcelik Children’s Hospital, Bursa, Turkey

    Emre Baldan

  2. Department of Pediatrics, Division of Neonatology, University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey

    Ipek Guney Varal, Pelin Dogan & Mehmet N. Cizmeci

  3. Department of Pediatrics, Division of Neonatology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada

    Mehmet N. Cizmeci

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  1. Emre Baldan
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Contributions

All authors contributed to the study conception, design and data collection. EB wrote the first manuscript draft. MNC critically reviewed and revised the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Emre Baldan.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki and approved by the Ethics Committee of the University of Health Sciences, Bursa Yuksek Ihtisas Teaching Hospital, Bursa, Turkey (2011-KAEK-25 2016/22-06).

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Written informed consent was obtained from the parents.

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Not applicable.

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The authors declare no conflict of interests.

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Communicated by Daniele De Luca

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Mehmet N. Cizmeci previously working at Institution #2.

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Baldan, E., Varal, I.G., Dogan, P. et al. The effect of non-invasive high-frequency oscillatory ventilation on the duration of non-invasive respiratory support in late preterm and term infants with transient tachypnea of the newborn: a randomized controlled trial. Eur J Pediatr 182, 4499–4507 (2023). https://doi.org/10.1007/s00431-023-05128-4

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