Can nasal high-flow oxygen replace CPAP for primary respiratory support in babies with respiratory distress syndrome?

For babies born prematurely with respiratory distress syndrome, nasal continuous positive airway pressure (CPAP) is the standard primary respiratory support. While nasal high-flow therapy is effective after a baby is taken off a ventilator, it is not safe to use as the first line of treatment for respiratory distress. Research shows that using high-flow oxygen as the primary method leads to much higher rates of treatment failure compared to CPAP.

What the research says

A major international trial found that using nasal high-flow therapy as the primary support for preterm infants with respiratory distress resulted in treatment failure in 25.5% of cases. In contrast, only 13.3% of infants treated with CPAP failed within the first 72 hours. This difference was large enough that the study was stopped early because high-flow therapy was found to be inferior to CPAP for this specific condition ⁶.

Another study compared different ventilation techniques but focused on surfactant administration methods rather than comparing high-flow oxygen directly to CPAP as a primary treatment. This research highlighted that while less invasive surfactant administration (LISA) has advantages, the specific comparison of high-flow versus CPAP for primary support remains distinct and unfavorable for high-flow ².

Other studies have looked at reducing the need for respiratory support through methods like antenatal steroids or comparing non-invasive high-frequency oscillation ventilation to CPAP. These trials found that alternative non-invasive methods like high-frequency oscillation were non-inferior to CPAP, but nasal high-flow oxygen specifically was not found to be a suitable replacement for CPAP in the primary setting ³⁴.

What to ask your doctor

• What is the standard of care for my baby's specific gestational age and lung condition?