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Clinical Trial
. 2025 Jun;45(6):817-822.
doi: 10.1038/s41372-025-02267-4. Epub 2025 Mar 23.

Changes in lung aeration with high-flow nasal cannula compared to nasal CPAP in preterm infants

Anup Katheria  1 , Felix Ines  2 , Judith Hough  3 , Wade Rich  2 , Ana Morales  2 , Shashank Sanjay  2 , Debra Poeltler  2 , Neil Finer  2
Affiliations
Clinical Trial

Changes in lung aeration with high-flow nasal cannula compared to nasal CPAP in preterm infants

Anup Katheria et al. J Perinatol. 2025 Jun.

Abstract

Objective: To compare the degree of atelectasis in preterm infants on nasal continuous airway pressure (nCPAP) versus high-flow nasal cannula (HFNC) at 8 L/min.

Study design: A cross-over study of infants <29 weeks gestational age (GA) receiving nCPAP and underwent 6-hours of HFNC at 8 L/min before returning to nCPAP. Electrical Impedance Tomography was used to measure lung aeration.

Results: 78 infants with median GA of 27 weeks [26, 28] were studied. HFNC was non-inferior to CPAP across the 4 periods (overall mean 2.1 ± 2.9, lower bound of confidence interval -0.9). Infants that failed HFNC had higher dependent silent spaces (DSS) measurements (1.6[0.48, 4.7] vs 0.30[0.0, 2.7], P = 0.046).

Conclusion: This study of premature infants <29 weeks GA at birth demonstrated that HFNC was non-inferior to nCPAP as measured by DSS. Infants that failed HFNC had a higher percentage of DSS than those who tolerated HFNC for 6 hours suggesting decreased lung aeration.

Clinicaltrials: gov ID: NCT03700606.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Approval was obtained from Sharp HealthCare Institutional Review Board under IRB#1807906. Consent was obtained from all participants and the study was performed in accordance with the Declaration of Helsinki.

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