P2C181: High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure for Transient Tachypnea of Newborn

Background: Transient Tachypnea of the Newborn (TTN) is a common cause of respiratory morbidity in late preterm and term infants. Infants with TTN nonresponsive to supportive management require non-invasive respiratory support, either High flow nasal cannula (HFNC) or nasal continuous positive airway pressure ( nCPAP), based on the institution’s practice, provider’s preference or equipment availability. There is a paucity of data comparing HFNC and nCPAP for the management of TTN. Our study aims to compare the effectiveness of HFNC and nCPAP for TTN.

Methods: A retrospective chart review of infants 34 weeks gestational age and birth weight 2 kg admitted to Hutzel Women’s Hospital between January 2020 and December 2021 with a diagnosis of TTN requiring respiratory support for >2 hours was conducted. Infants with congenital anomalies, pneumonia, and sepsis were excluded. Data were collected for maternal and infant demographics, antenatal complications, neonatal resuscitation, and respiratory and feeding outcomes. The primary outcome was treatment failure within 24 hours of initiation of study mode, defined as meeting one or more of the following: increase in the fraction of inspired oxygen (FiO2) by 15% from the baseline, pH < 7.2 with pCO2 > 60 in two consecutive blood gases drawn one hour after initiation of the study mode and obtained at least an hour apart, two episodes of apnea requiring positive pressure ventilation (PPV), need for escalation of respiratory support to non-invasive positive pressure ventilation or mechanical ventilation. Secondary outcomes included duration of respiratory support, maximum FiO2, day of initiation of feeds to full feeds, and total stay. Statistical analysis included t-test, chi2, Fisher’s exact, Mann-Whitney U tests, and logistic regression to compare treatment failure in two groups after adjusting for gestational age (GA), maternal diabetes (DM), and meconium-stained amniotic fluid (MSAF).

Results: Our study cohort included 198 infants (109 in the HFNC group and 89 nCPAP group); 178 (89.9%) were African American, 111 (56%) were male, mean± SD GA was 37.7±1.9 weeks, and birth weight was 3103 ± 653 grams. A higher proportion in the nCPAP group required PPV (28% vs. 14.7%) and CPAP (58% vs. 13.9%) in the delivery room compared to the HFNC group (Table 1). Treatment failure was not statistically different between HFNC and nCPAP (13.8% vs.13.5%, p-value 0.95). Enteral feeds and nippling were initiated earlier in HFNC compared to the nCPAP group (Table 2).

Regression analysis after adjusting for GA, DM, and MSAF did not show a significant difference (OR 1.16, 95% CI 0.49-2.75, p-value 0.73) in treatment failure between HFNC and nCPAP.

Conclusion: HFNC and nCPAP have similar effectiveness in managing infants with TTN. Initiation of nipple feedings can get delayed on nCPAP.