341 - Effect of Placing Pre-Term Infants on High Flow Nasal Cannula before 36 weeks on Time to Full Oral Feeding

Publication Number: 2330.341

Kirsten McCullum, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Nikhil Deshmukh, University of Missouri-Columbia School of Medicine, Chesterfield, MO, United States; Ganasri Aleti, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Emma Baer, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Akshaya J. Vachharajani, University of Missouri, Columbia, MO, United States

Background: Studies describe that placing pre-term infants on high flow nasal cannula (HFNC) may be associated with achieving full oral feeds (FOF) earlier than those on continuous positive airway pressure (CPAP) (Leibel et al, PMID: 32138561). They switched infants on CPAP and/or HFNC to low-flow oxygen around feeding time to allow oral feeds and then switched them back to their original support. Infants in our NICU may be switched to HFNC (without switching them back to CPAP) in the belief that they may get to FOF sooner than those who are left on CPAP.

Objective: We studied the effect of switching to HFNC before 36 weeks corrected gestational age (CGA) on the time to FOF and the effects on the incidence of bronchopulmonary dysplasia (BPD).

Design/Methods: IRB approved retrospective electronic chart analysis of pre-term infants born between January 1, 2020 and December 31, 2024 at less than 32 weeks gestation admitted and surviving the neonatal intensive care unit (NICU) stay was performed. Time to FOF (150ml/kg/day) in infants treated with HFNC before 36 weeks CGA was compared to those treated with only CPAP. Infants with medical or surgical NEC, intestinal surgery, or gastrostomy tube were excluded. Data were stored on RedCap Database. Statistical analyses included Chi-squared tests for categorical data, and Mann-Whitney U or paired T-tests for continuous variables. A p-value < 0.05 indicated statistical significance.

Results: A total of 170 preterm infants born at less than 32 weeks gestation were placed on HFNC or CPAP (51 HFNC, 119 CPAP). Time to full oral feeds was not statistically significant between the two groups. BPD was diagnosed in a significantly higher number of infants in the HFNC group (p < 0.00001). No significant difference was found between the HFNC and CPAP groups in regard to gestational age, birth weight, duration of invasive ventilation, maternal receipt of antenatal steroids, use of postnatal steroids, or the presence of maternal diabetes (Table 1).

Median number of days to reach FOF was 21 days in the HFNC group (IQR 10, 29) and 18 days in the CPAP group (IQR 11, 28; p=0.9124). Median length of stay and duration of non-invasive ventilation were significantly higher in the HFNC group (Table 1).

Conclusion(s): Infants placed on HFNC did not reach FOF earlier, had longer length of NICU stay, and increased incidence of BPD.

Table 1: Comparison of Demographics and Outcomes Between CPAP and HFNC Groups
Table 1: Comparison of Demographics and Outcomes Between CPAP and HFNC Groups