Background / Aims: The incidence of premature delivery (<37 weeks) has been steadily increasing in New Zealand, and accounts for 8% of births, with respiratory distress being the most common cause of morbidity. Local data indicates that infants less than 30 weeks gestational age (GA) have a median duration on respiratory support of 43 days. In recent years the use of HHHFNC has been promoted as an alternative to nCPAP. This is because while on nCPAP, infants require intensive nursing, with careful attention to positioning, suctioning and avoidance of nasal trauma, which is a frequent complication. Also, while on nCPAP infants are unable to initiate suck feeding and it is often difficult to wean off nCPAP. The length of time on respiratory support is associated with significant morbidity, and reducing the duration and intensity of this is associated with improved outcomes. Early introduction of oral feeding is associated with enhanced motor skills, earlier attainment of full suck feeds and could potentially reduce stay in Neonatal Intensive Care Units (NICU).
Current evidence for clinical success of HHHFNC therapy is limited, although recent studies suggest that its use is safe and non-inferior to nCPAP. In June 2015, the CHiPS study commenced in the NICU at Middlemore Hospital. The primary aim of this study is to determine the safety and efficacy of weaning preterm infants from nCPAP to HHHFNC versus continued use of nCPAP for respiratory support. Other aims will compare adverse events, nasal trauma, feeding practices, nursing acuity, costs and parental satisfaction across both forms of respiratory support.
Methods: This is a single-centre, prospective, RCT. 120 preterm infants born at GA <30 weeks are being recruited over a period of 3 years. Once these infants meet the stability criteria on nCPAP 6cm water, they will undergo randomisation to either continue on nCPAP (control) or commence HHHFNC (intervention) and will remain in the study until 36 weeks corrected gestational age.
The primary outcome is the duration (in hours) of respiratory support from randomisation to achieving 72 hours free of respiratory support.
Counties Manukau Health