Elsevier

The Journal of Pediatrics

Volume 227, December 2020, Pages 135-141.e1
The Journal of Pediatrics

Original Article
Predicting Nasal High-Flow Treatment Success in Newborn Infants with Respiratory Distress Cared for in Nontertiary Hospitals

https://doi.org/10.1016/j.jpeds.2020.07.037Get rights and content

Objective

To evaluate demographic and clinical variables as predictors of nasal high-flow treatment success in newborn infants with respiratory distress cared for in Australian nontertiary special care nurseries.

Study design

A secondary analysis of the HUNTER trial, a multicenter, randomized controlled trial evaluating nasal high-flow as primary respiratory support for newborn infants with respiratory distress who were born ≥31 weeks of gestation and with birth weight ≥1200 g, and cared for in Australian nontertiary special care nurseries. Treatment success within 72 hours after randomization to nasal high-flow was determined using objective criteria. Univariable screening and multivariable analysis was used to determine predictors of nasal high-flow treatment success.

Results

Infants (n = 363) randomized to nasal high-flow in HUNTER were included in the analysis; the mean gestational age was 36.9 ± 2.7 weeks and birth weight 2928 ± 782 g. Of these infants, 290 (80%) experienced nasal high-flow treatment success. On multivariable analysis, nasal high-flow treatment success was predicted by higher gestational age and lower fraction of inspired oxygen immediately before randomization, but not strongly. The final model was found to have an area under the curve of 0.65, which after adjustment for optimism was found to be 0.63 (95% CI, 0.57-0.70).

Conclusions

Gestational age and supplemental oxygen requirement may be used to guide decisions regarding the most appropriate initial respiratory support for newborn infants in nontertiary special care nurseries. Further prospective research is required to better identify which infants are most likely to be successfully treated with nasal high-flow.

Trial registration

ACTRN12614001203640.

Section snippets

Methods

The HUNTER trial (Australian and New Zealand Clinical Trials Registry ACTRN12614001203640) was conducted in nine Australian SCNs, and compared nasal high-flow delivered at flows of 6-8 L/min with CPAP delivered at pressures of 6-8 cm H2O as primary respiratory support for newborn infants with respiratory distress.6,8 The peripheral oxygen saturation target range was 91%-95% for all infants receiving supplemental oxygen. Infants were eligible to be enrolled in the trial if they were born at

Results

Of the 381 infants randomized to nasal high-flow treatment, 18 infants who never received nasal high-flow were excluded, leaving 363 infants in the analysis (337 singletons and 26 from twins). The cohort (Table I; available at www.jpeds.com) had a mean gestational age of 36.9 ± 2.7 weeks and birth weight of 2928 ± 782 g; 177 infants (49%) were born preterm (<37 weeks of gestation) and 232 (64%) were male. The median age at high-flow treatment commencement was 1.4 hours (IQR, 0.9-2.5 hours), and

Discussion

This study examined predictors of nasal high-flow treatment success in newborn infants enrolled in an RCT of early noninvasive respiratory support in Australian nontertiary SCNs.

In this secondary analysis of the HUNTER trial, predictors of nasal high-flow treatment success on univariable analysis and multivariable analysis included higher gestational age and lower FiO2 immediately before randomization. Nasal high-flow treatment success was not strongly predicted by a model that included these

Data Statement

Data sharing statement available at www.jpeds.com.

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  • Cited by (4)

    Supported by the Medical Research Future Fund (Australia) Next Generation Clinical Researchers Career Development Fellowship (1159225 [to B.M.]); National Health and Medical Research Council (Australia), Career Development Fellowship (1159444 [to L.O.]); National Health and Medical Research Council (Australia), Emerging Leadership Grant (1175634 [to C.R.]); National Health and Medical Research Council (Australia), Practitioner Fellowship (1157782 [to P.D.]). The authors declare no conflicts of interest.

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